Inactive Mucosal Chronic Otitis Media Research Articles

Surgical Outcomes of Tympanoplasty with Various Graft Materials in Chronic Otitis Media: A Retrospective Cohort Study

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neoTM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Interlay Type-1 Tympanoplasty with or Without Cortical Mastoidectomy in an Inactive Mucosal Chronic Otitis Media with Large Central Perforation: A Retrospective Comparative Study.

The online version contains supplementary material available at 10.1007/s12070-023-03781-7.

Relationship of Hearing Loss and Tympanic Membrane Perforation Characteristics in Chronic Suppurative Otitis Media Patients.

Objective The objective of this study is to assess the relationship between the site of tympanic membrane (TM) perforation and the type and degree of hearing impairment. The secondary objectivewas to compare the duration of the disease and the degree of hearing loss. Study design This is a prospective observational study. Place and duration of the study This study was carried out in the Department of Otolaryngology/Head and Neck Surgery at the Pakistan Institute of Medical Sciences, Islamabad, from May 2021 to April 2022. Patients and methods Of all the screened patients, 77 fulfilled the inclusion criteria. Patients aged 10-40 years with inactive mucosal chronic otitis media and unilateral perforation in one quadrant were included. The site of TM rupture was observed, and audiometric analysis was performed. Results The mean age of participants was 25 ± 8.61 years, with a preponderance of the female gender (57.1%). A total of 32 (41.6%), 19 (24.7%), 19 (24.7%), and seven(9.1%) perforations involved posterosuperior, anterosuperior, anteroinferior, and posteroinferior quadrants respectively. Conductive, mixed, and sensorineural hearing loss was found in 52 (67.5%), 18 (23.4%), and seven (9.1%) cases, respectively. Of all the subjects, 13 (16.9%) had the disease for < one year, 39(50.6%) for one to five years, 17 (22.1%) for five to 10 years, and eight (10.4%) for > 10 years. There was a statistically significant association between the degree of hearing loss and the site of perforation. No significant association was found between the site of perforation and thetype of hearing loss. Duration of disease and degree of hearing loss also had no significant association. Conclusion The extent of hearing loss was found to be directly influenced by the anatomical site of perforation, with the posterosuperior quadrant perforation producing the greatest degree of impairment.

Cartilage palisades versus temporalis fascia: a randomised control trial

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Tympanic membrane perforation is a common cause of hearing loss. Various surgical techniques with different graft materials have been described for the treatment of perforations. The most widely used graft materials are the cartilage and temporalis fascia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We conducted a prospective randomised control longitudinal study to document the post operative hearing outcomes of type 1 tympanoplasty in patients with inactive mucosal chronic otitis media (n=120) using the cartilage palisades tympanoplasty technique (n=60) and temporalis fascia (n=60).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; It was found that the mean AB (air-bone) gap at 5 months post operatively was 12.35±7.17 dB with temporalis fascia and 11.39±7.907 dB in cartilage palisades tympanoplasty. At 12 months the AB gap was 14.98±9.915 dB in temporalis fascia group as compared 11.41±8.288 dB for cartilage palisades group. Thus, hearing improvement was better in cartilage palisades group, but interestingly the comparison of the air conduction gain and subjective improvement at the end of 5 and 12 months between the two techniques was not statistically significant and parallels the above findings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Hence we conclude that both temporalis fascia and cartilage palisades were acceptable graft material for successful closure of tympanic membrane perforation.&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.

Endoscopic Type I Tympanoplasty in 70 Patients with Chronic Otitis Media: A Preliminary Report

ABSTRACT&#x0D; Objective: To evaluate the preliminary surgical results of Endoscopic Type I Tympanoplasty&#x0D; among patients with inactive chronic otitis media without ossicular pathology.&#x0D; Methods:&#x0D; Design: Prospective Series&#x0D; Setting: Tertiary Government Hospital&#x0D; Participants: Seventy patients with inactive mucosal chronic otitis media (COM) with air bone gap (ABG) of ≤ 40 dB on the preoperative audiogram scheduled to undergo Type I Tympanoplasty between July 2018 and December 2020 were enrolled.&#x0D; Results: Seventy-three (73) ears were evaluated. The overall rate of graft uptake was 95.9% at 12 weeks. There was a statistically significant (p&lt;.001) improvement in hearing on comparison of pre-operative (25.74 ± 7.34 dB) and post-operative (14.82 ± 6.55 dB) air bone gap. The duration of surgery was less than one hour in 76.7% and 77.2 % patients experienced only mild post[1]operative pain.&#x0D; Conclusion: Endoscopic tympanoplasty can provide good results with respect to graft uptake and hearing gain with short surgical duration and minimum postoperative morbidity. Longer follow up of at least 6 months (for graft uptake) and preferably not less than 12 months (for hearing results) may confirm our preliminary findings

Outcome of Interlay Type 1 Tympanoplasty for Large Central Perforation

Background: Perforation of the tympanic membrane may occur from various reasons. Most of these perforations heal spontaneously, whereas the remaining long-standing perforations that lead to recurrent ear discharge need tympanoplasty. Interlay Type 1 Tympanoplasty,a newer technique has shown promising results with higher success ratein terms of hearing gain and graft uptake.&#x0D; Objective: To analyze the results of interlay Type 1 Tympanoplasty in terms of graft uptake and hearing improvement in cases of inactive mucosal chronic otitis media (COM) with large central perforation.&#x0D; Methods: This is a prospective study of 24 months (January 2018 to December 2019) duration conducted in department of E.N.T, Khulna medical college, Khulna and data was collected from the 60 patients admitted for tympanoplasty. Results were calculated in terms of graft accepted or rejected and decrease in air bone gap.&#x0D; Result: The graft uptake rate in the present study was found to be 91.67% and the patients reported an improvement in terms of hearing. Pre operatively mean air bone gap was 26.5dBand post operatively after 12 weeks mean air bone gap improved to 17.58dB.&#x0D; Conclusion: Interlay Type 1 Tympanoplasty is an effective technique over conventional methods in terms of both graft uptake as well as hearing improvement in large central perforation.&#x0D; Bangladesh J Otorhinolaryngol; April 2021; 27(1): 86-91

Outcome of underlay versus interlay tympanoplasty in patients with inactive mucosal chronic otitis media with large central perforation: a retrospective comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Aim and objective were to study the outcome of underlay versus interlay tympanoplasty in patients with inactive mucosal chronic otitis media with large central perforations in terms of graft uptake rate and hearing improvement. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was conducted retrospectively on 110 patients of inactive mucosal chronic otitis media with large central perforation, 55 patients selected from each group undergoing underlay or interlay technique in a tertiary referral hospital, Department of ENT, ESIC Kalaburagi, Karnataka, from February 1 2018 to January 31, 2020. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total 110 patients were included in the study. Male:female ratio was 1:2.2. The age group in this study ranged from 13-50 years of age. Preoperative mean air bone gap in groups A and B was 30.28±6.62, and 30.18±6.87 dB and postoperative mean air bone gap was 19.44±7.66 and 15.13±6.3 dB. In both the groups a significant mean reduction in air bone gap was observed. Mean reduction was maximum in group B. Statistically, intergroup difference in reduction in air bone gap was highly significant (p&amp;lt;0.001). Graft success rate being 89.09% and 94.54% in underlay (group A) and interlay (group B) respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Interlay is a better technique than underlay in chronic otitis media inactive mucosal disease with large central perforation in terms of hearing improvement and graft uptake. &lt;/p&gt;

Effectiveness of underlay myringoplasty in inactive mucosal chronic otitis media; a prospective study

Introduction: Patients with a mucosal type of chronic otitis media (COM) usually have recurrent ear discharge and conductive hearing loss. It is characterized by the central perforation of the tympanic membrane. Myringoplasty is an operation performed to repair tympanic membrane perforation when there is no ossicular damage. It helps to prevent ear discharge and improves hearing. Different techniques used for myringoplasty are underlay and overlay. Underlay technique is an effective procedure for tympanic membrane repair. Methods: 125 patients who underwent underlay myringoplasty over two years in a tertiary care center in Kerala were included in the study. Patients with actively discharging ears were excluded from the study. Results: The majority of the patients were in the age group of 20-29 years (49.6%). There were 47 males (37.6%) and 78 females (62.4%). In 63 patients the surgery was done on the right side (50.4%) and in 62 patients on the left side (49.6%). Maximum preoperative hearing loss was in the range of 30-34 dB (39.2%). 100 patients (80%) showed successful graft uptake with the improvement of hearing in the range of 10-15 dB. Eight patients (6.4%) showed small residual perforation with the improvement of hearing. In 17 patients (13.6%) there was a complete rejection of graft with continuous ear discharge and no improvement in hearing. Conclusion: Underlay myringoplasty is an effective surgical technique for the repair of tympanic membrane perforations in terms of graft take up and improvement of hearing.

Prospective study on technique of graft fishing with anterior tucking in type 1 tympanoplasty and its hearing outcome

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic otitis media (COM) is a common health problem in developing world and has a major impact on patient in the form of hearing loss. Temporalis fascia is commonest graft material used for tympanoplasty as it is readily available through same post aural incision. The study was conducted with an aim to find out the effectiveness of fishing technique and anterior tucking in terms of graft stability, graft uptake, hearing improvement and complications.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The present study is prospective study conducted on patients with complains of otorrhea and hearing loss, of age between 15 to 60 years, during the period January 2017 to June 2018. Patients with inactive mucosal COM and pure conductive hearing loss who underwent type-I tympanoplasty were included. Patients with cholesteatoma, ossicular pathology, trauma, mixed or sensorineural hearing loss, were excluded. Paired ‘t’ test was applied to compare preoperative and postoperative mean air-bone gap.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study total 123 patients were analysed for the follow-up period of 6 months and it was observed that graft was well accepted in 93.5% patients while in 4.8% patients residual anterior perforation was found and in 1.7% patients the graft was completely rejected, showing an overall success rate at the end of 6 months follow-up to be 93.5%. There was a statistically significant improvement in hearing gain at the end of 6 months follow-up (p&amp;lt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Tympanoplasty with temporalis fascia graft using fishing and anterior tucking technique gave good dimensional stability to graft, preventing lateralization / medialization of graft. The superiorly based circumferential flap allowed for 360 degree placement of graft and anterior tucking, with overall high success rate and lower rate of complications and graft rejection.&lt;/p&gt;

A study of factors affecting the success rate of type-1 tympanoplasty

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic otitis media (COM) (tubo-tympanic) is a common ear pathology for which tympanoplasty is done. Factors that affect the success rate of tympanoplasty can be patient related (age, gender, socio-economic status), disease related (duration and severity of symptoms) or technique related (equipment and surgical approaches). This study was undertaken to know the factors affecting success rate of type-1 tympanoplasty at our institute.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a prospective observational study conducted at ENT Department of Gujarat Adani Institute of Medical Sciences, Bhuj, from October 2017 to July 2019. All patients between 20 and 60 years of age with inactive mucosal COM operated for type-1 tympanoplasty were included in the study. Pre-operative, intra-operative and post-operative details were recorded as per the pre validated proforma and evaluated using Chi-square and paired t-test.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;100 patients were included in our study. Females were more commonly affected (61%) than males (39%). In 78% of patients one ear was affected (left 40%, right 38%). Ear discharge was the most common symptom (99%). Maximum patients (55%) had a moderate perforation. The perforation was central in all cases. Microscopic surgery was done in 79% of patients. Post aural approach (Wilde’s incision) was the most common approach used (70%). The most common graft material used was temporalis fascia (96%). In 61% of patients graft was kept by underlay technique.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In our study, the success rate of tympanoplasty was significantly more when duration of discharge was less, microscope was used for surgery and post aural approach was used. Success rate was less when there was history of any previous nasal pathology. Other factors, like age, gender, socio-economic class, occupation, side of involvement of ear, size and site of perforation and grafting techniques, did not affect the success rate of tympanoplasty.&lt;/p&gt;

A Study of Correlation Between Tympanic Membrane Perforation Size With Hearing Loss in Patients With Inactive Mucosal Chronic Otitis Media.

This study is directed towards establishing a correlation between the objective measurement of tympanic membrane (TM) perforation size with hearing loss in patients with inactive mucosal chronic otitis media (COM), and to compare the otoscopic findings of the TM perforation vis-a-vis the results obtained by image analysis of the endoscopic image of the perforation. An observational, prospective and hospital based study was performed on 107 ears (78 patients) with inactive mucosal chronic otitis media. Objective measurement of the TM perforation size was done by capturing the images of the perforation on ImageJ analysis software. A correlation was established between the hearing loss and the perforation with respect to its size and location. The accuracy of the otoscopic finding of the perforation was established with respect to the endoscopic image of the perforation. The extent of the hearing loss was seen to increase with increasing size of the TM perforation (r = 0.435, p < 0.0001). Posterior perforations had a 12% greater hearing loss than anterior perforations but this was significant only at the frequency of 500 Hz (p = 0.02). There was a positive correlation between the otoscopic estimation of the size of the perforation with the endoscopically obtained image. Hearing loss in chronic otitis media is directly proportional to the size of the TM perforation and posteriorly based perforations have worse audiometric thresholds at lower frequencies (500 Hz).

Reinforced temporalis fascia with conchal cartilage versus exclusive temporalis fascia grafting in type 1 tympanoplasty: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Various grafting materials have been used for the repair of a tympanic membrane perforation over the years, with temporalis fascia and conchal cartilage being the most widely used. Our study is an attempt to compare and analyse the use of exclusive temporalis fascia as grafting material against a reinforced graft consisting of temporalis fascia and conchal cartilage.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study of 100 patients having inactive mucosal chronic otitis media with a dry central perforation with moderate conductive hearing loss, undergoing type 1 tympanoplasty using underlay technique. 50% of the subjects were grafted with temporalis fascia alone while a reinforced temporalis fascia graft along with conchal cartilage was used in the remaining 50% of the cases. The results were evaluated at an interval of 24 weeks after surgery on the basis of graft uptake and hearing restoration (closure of air-bone gap &amp;lt;10 dB). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Graft uptake in exclusive temporalis fascia grafting was 86% while it was 94% when a reinforced graft was used; the hearing restoration rates in both the groups were 82% and 80% respectively. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Reinforced temporalis fascia grafting along with conchal cartilage gives better results than grafting with temporalis fascia alone as regards to graft uptake, while the audiometric results are comparable in both the groups. &lt;/p&gt;

A Randomized Prospective Study on Interlay Vs Underlay of Type I Tympanoplasty in Remote Tertiary Center

Background: Type I tympanoplasty is a surgical technique used to restore the integrity of tympanic membrane as well as improve the hearing in inactive mucosal chronic otitis media. There are two main methods that are underlay and overlay in between both is interlay. The aim of the present study is to analyse and compare the results of the two most commonly used type I tympanoplasty techniques, underlay and the interlay technique in chronic otitis media with mucosal disease in large central perforation, in terms of graft uptake and hearing improvement. Subjects and Methods: This is a randomized prospective study of 100 cases of inactive mucosal chronic otitis media with total or large anterior central perforation between October2017 to September 2019 in Anugarah Narayan Magadh Medical College &amp; Hospital, Gaya. Half had gone through Interlay and half by Underlay technique of Type I Tympanoplasy surgery. Results: The graft uptake rate in this study was 96% and 90% for Interlay and Underlay technique respectively. Postoperatively mean air bone gap maximally reduced in the Interlay technique. Conclusion: The present study showed that Interlay method had better graft uptake rate as well as hearing improvement in total and large anterior central perforation of inactive mucosal chronic otitis media than the Underlay technique.

Comparative study of different approaches of myringoplasty in chronic otitis media

Objectives: To determine the best surgical approach of myringoplasty regarding healing of tympanic membrane and improvement of hearing.&#x0D; Methods: This was a cross sectional comparative study carried out in the departments of Otolaryngology and Head-Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital, Sir Salimullah Medical college Mitford Hospital and Shaheed Suhrawardy Medical College Hospital during the period of July’2009 to March 2011. A total number of 75 patients of age 15-45years having inactive mucosal chronic otitis media with central perforation were included in this study. All patients has undergone myringoplasty and patients were divided into three groups according to surgical approach such as postaural, transcanal and endaural. All patients were followed up postoperatively and all postoperative findings were recorded. The three groups were compared with regard to healing of tympanic membrane and improvement of hearing.&#x0D; Results: The success rate in this study was 80% . graft take rate in postaural, transcanal and endaural approaches were 92.5%, 66.67% and 63.64% respectively. Improvement of mean airbone gap in postaural, transcanal and endaural approaches were 19.04dB, 10.02dB and 11.36dB&#x0D; Conclusion: Graft take rate and hearing improvement is significantly higher in postaural approach than other approaches.&#x0D; Bangladesh J Otorhinolaryngol; April 2016; 22(1): 21-25

Correlation of Tympanic Membrane Perforation with Hearing Loss and Its Parameters in Chronic Otitis Media: An Analytical Study.

Chronic otitis media is one of the commonest illnesses in otorhinolaryngological practice which requires medical attention. Intact tympanic membrane acts as a shield for round window niche to create a phase difference in sound wave conduction. 700 patients of age 10-70years with inactive mucosal chronic otitis media were included in the study. Condition of tympanic membrane and site of tympanic membrane perforation was noted and audiometric analysis was performed. 338 (48.28%) were males and 362 (51.71%) were females. In 1400 membranes examined, 769 (54.85%) presented with perforation. 631 (82.03%) had unilateral perforation and 69 (17.97%) had bilateral perforations. In unilateral cases, 289 (37.50%) had right ear perforation and 342 (44.53%) left ear perforation. Single quadrant perforations were present in 168 (21.74%) membranes and 419 (54.55%) involved two quadrants. Three quadrant perforations were seen in 62 (8.09%) and 120 (15.63%) perforations involved all four quadrants. In 171 (22.26%) ears, perforation was present anterior to handle of malleus and in 243 (31.53%) it was present only posterior to handle. In 355 (46.21%) perforations, handle of malleus was involved. Perforations involving posterior half of tympanic membranes showed greater loss than those involving anterior or inferior half of membrane statistically. Maximum loss (51.56 ± 5.1dB) was seen in perforation involving all four quadrants. In 631 unilateral cases, conductive loss was seen in 424 (67.10%), 101 (16.10%) showed sensorineural and 74 (11.80%) showed mixed loss. Out of 769 perforated ears having hearing loss, 251 (37.69%) had complaints for 5-10years with mean loss of 51.15 ± 7.8dB, 172 (25.68%) had COM for 1-5years with loss of 39.26 ± 5.1dB. A mean hearing loss of 52.18 ± 4.2dB was seen in 110 (16.52%) patients suffering from COM for more than 10years. 134 (20.12%) patients having disease less than 1year reported hearing loss of 36.46 ± 8.2dB. The effects of perforation of tympanic membranes on transmission of sound and its dynamics are not easy to correlate because of additional pathological changes in middle ear.

Tympanoplasty with and without cortical mastoidectomy in treatment of inactive mucosal chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympano-mastoidectomy has been found to be an effective method of treatment of chronic ear infection, but the effect of mastoidectomy on patients without evidence of active infectious disease in mastoid remains highly debated and unproven. Analyse the surgical outcomes of repair of uncomplicated tympanic membrane perforations with tympanoplasty alone and tympanoplasty combined with mastoidectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present study was a prospective, comparative, randomized controlled trial in which 60 patients 30 in each groups via simple random sampling technique underwent tympanoplasty with cortical mastoidectomy. Temporalis fascia was used as graft in all the cases. All the surgeries were done by post aural route and underlay technique was used in all cases. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The overall graft uptake rate in our study was 88.33%. The graft uptake rate in tympanoplasty group was 87% and 90% in the tympanoplasty with cortical mastoidectomy group. There was no significant difference in the graft uptake rates of the two groups. There was no statistical significance between the two groups as p&amp;gt;0.05, suggesting that mastoidectomy when combined with tympanoplasty offers no benefit over tympanoplasty alone. There was no significant difference in hearing gain between the two groups as p value obtained was &amp;gt;0.05.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Tympanoplasty alone is sufficient in patients with chronic inactive mucosal otitis media, as the results of the graft uptake and hearing improvement show no significant difference between the tympanoplasty group and the tympanoplasty with cortical mastoidectomy group.&lt;/p&gt;

COMPARATIVE STUDY OF ENDOSCOPIC AND MICROSCOPIC ASSISTED MYRINGOPLASTY IN TIRUMALA HOSPITALS, KADAPA

Objective: The main aim of the study is to assess the operative time, graft uptake and audiological gain and post-operative scar in the group of the patients undergoing the endoscope assisted and the microscope assisted myringoplasty in Tirumala Hospital, Kadapa.&#x0D; Material and Methods: Myringoplasty or type-1 tympanoplasty was performed by either the endoscope or the microscope assistance. Postaural approach was undertaken for microscope assisted myringoplasty. Underlay technique of myringoplasty was performed using temporalis fascia graft in all the patients suffering from the inactive mucosal chronic otitis media. Post operative evaluation was done in terms of operative time, graft uptake and audiological gain. The patients were followed up for a period of 6 months. The study was longitudinal in nature and comprised of 100 patients suffering from the chronic otitis media inactive mucosal disease. The patients are divided into two groups consisting of 50 in each group. One group of patients have undergone microscopic assisted myringoplasty one group undergone endoscopic assisted myringoplasty and were followed up regularly. Study period is one year from January 2016 to December 2016 attending outpatient otolaryngology department were included in the study.&#x0D; Results: The operative time in the patients undergoing the endoscope assisted myringoplasty(EAM) was 45minutes whereas it was 60 minutes in the patients undergoing the microscope assisted myringoplasty(MAM). The tympanic membrane graft uptake and audiological gain was assessed at 1 month, 3months and 6 months post operatively. The successful closure of the tympanic membrane perforation was higher with the endoscope assisted myringoplasty as compared to the microscope assisted myringoplasty at 1 month, 3 months and 6 months of follow up. The mean audiological gain following myringoplasty with both the techniques used was noted. The mean audiological gain was found to be marginally better with the endoscope assisted myringoplasty at follow up of 1, 3 and 6 months as compared to the microscope assisted myringoplasty.&#x0D; Conclusion: The operative time was less in the endoscope assisted technique as compared to the microscope assisted technique. The post operative morbidity (evaluated in terms of post operative scar) was less in the group of patients undergoing the Transcanal endoscope assisted as compared to microscope assisted myringoplasty. There was no significant difference in either graft uptake or post-operative audiological gain in the patients undergoing myringoplasty by endoscope assisted and microscope assisted technique. The endoscope assisted myringoplasty has advantages of better assessment of ossicular chain and in the patients with canal overhang it improves the visualisation of the margins of the perforation thus obviating the need for canalplasty. Thus the endoscope assisted myringoplasty can be used as a preferred alternative to the conventional microscope assisted myringoplasty, with better post operative results and reduced operating time and morbidity of the surgical procedure.&#x0D; Keywords: Chronic otitis media (COM); Myringoplasty; Endoscope assisted myringoplasty; Microscope assisted myringoplasty.

Endoscopic myringoplasty: outcome and hearing gain in inactive mucosal chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media is an inflammatory process in the middle ear cleft that poses serious health problem in developing countries. Myringoplasty is a common otological procedure to reconstruct the tympanic membrane to prevent recurrent otorrhea, and restore sound-conducting mechanism. The use of rigid endoscope in transcanal myringoplasty has significant advantage as it provides magnified, close up as well as wide angle view, less morbidity and early postoperative wound healing with better cosmetic results without compromising success rate and postoperative hearing gain. The aims and objectives of the study were to analyze the results of endoscopic transcanal interlay myringoplasty, in terms of graft uptake and hearing improvement in cases of chronic suppurative otitis media with inactive mucosal disease with central perforation.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study conducted from January 2016 to August 2018 in 30 patients of inactive mucosal chronic otitis media (COM). All patients underwent transcanal endoscopic interlay myringoplasty and patients were called for regular follow up for 12 weeks and results were statistically analysed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The graft uptake rate in the present study was found to be 93.33%. Pre operatively mean air bone gap (ABG) was 27.33 dB and post operatively after 12 weeks mean air bone gap improved to 10.5 dB. Mean ABG gain was 16.33%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic transcanal interlay myringoplasty with superiorly based TM flap is an effective technique over conventional microscopic technique in terms of graft uptake, hearing improvement, better postoperative scar and less morbidity in cases of inactive mucosal COM.&lt;/p&gt;

Interlay versus underlay type 1 tympanoplasty: a comparative study of the techniques in 100 cases

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Type 1 tympanoplasty is a surgical technique used to restore the integrity of tympanic membrane as well as to improve hearing level in patients with large central perforations (inactive mucosal chronic otitis media).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a randomized prospective study of 12 month duration from January 2017 to December 2017 in 100 patients of chronic otitis media inactive mucosal type with large central perforation admitted in the E.N.T department at Geetanjali Medical College and Hospital, Udaipur. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The graft uptake rate in the present study was found to be 96% and 90% respectively in interlay and underlay techniques. Post operatively after 12 weeks mean air bone gap was maximum reduced in Interlay tympanoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The present study showed that Interlay technique had a better graft take rate as well as hearing improvement in large central perforation of chronic otitis media than the underlay technique.&lt;/p&gt;