Mean Air-bone Gap Research Articles

Comparison of endoscopic and microscopic methods in stapedotomy: a retrospective analysis.

The goal of the present study was to compare the audiologic results, complications, and advantages/disadvantages of endoscopic and microscopic stapedotomy. Patients who experienced stapedotomy surgery in the Ear Nose Throat Clinic (ENT) of Selcuk University Faculty of Medicine between September 2011 and January 2018 were included in the study. The data of all patients were analyzed and divided into two groups. Those who underwent endoscopic stapedotomy were included in group I, and patients who underwent microscopic stapedotomy formed group II. Surgical findings, complications, and operation times were compared for the two groups. Air and bone conduction thresholds were evaluated at the frequencies of 500, 1000, 2000, and 4000Hz pre- and postoperatively at 1, 3, and 6months, and the mean (± SD) air-bone gap value was recorded. While the mean pre- and postoperative air-bone gaps were 34.38 ± 7.47dB (23-53dB) and 9.69 ± 4.43dB (0-19dB), respectively, in group I, 34.32 ± 7.57dB (23-6dB) and 9.62 ± 4.25dB (2-23dB) were the respective means calculated in group II (p < 0.05). When the mean postoperative air-bone gap was compared, there was no statistically significant difference between the two groups (p = 0.774). The mean operative times for groups I and II were 57.22 ± 4.37min and 63.70 ± 7.34min, respectively (p < 0.001). The requirement for chorda tympani nerve manipulation and scutum curettage was significantly less in group I compared to group II (p = 0.003). Postoperative dysgeusia and postoperative pain were found to be higher in group II than group I, but they were not statistically significant (p > 0.05). Endoscopic stapedotomy displayed similar audiological results, shorter operation times, and similar complication rates, as well as being a less invasive surgery, compared to the microscopic approach.

Total ossicular chain reconstruction using a titanium prosthesis: functional results.

To evaluate the efficacy and safety of a titanium total prosthesis (TORP) in ossicular chain reconstruction. Retrospective analysis of 113 cases of total ossicular chain reconstruction performed by a single surgeon between 2006 and 2018. Follow-up lasted until January 2020. Participants were patients with chronic otitis media, cholesteatoma, or ossicular chain disruption. Mean preoperative air-bone gap (± standard deviation) was 32.74dB (± 11.62). Mean postoperative air-bone gap was 21.68 (± 11.29). Mean air-bone gap improvement was 11.06dB (± 14.99) (p < 0.001). 57 cases had a post-operative air-bone gap smaller than or equal to 20dB (50.44%). In four cases, prosthesis dislocation was observed (12.39%). Mean prosthesis length in this group was 5.29mm (± 0.86) versus 4.36mm (± 1.02) in cases without prosthesis dislocation (p = 0.002). Total ossicular reconstruction using a titanium prosthesis yields favorable functional results, also during prolonged follow-up. Prosthesis length was significantly longer in cases with prosthesis dislocation.

Effect of Hydrogen Inhalation Therapy on Hearing Loss of Patients With Nasopharyngeal Carcinoma After Radiotherapy.

ObjectiveTo evaluate the clinical efficacy and safety of hydrogen inhalation in improving hearing loss in patients with long-term survival of nasopharyngeal carcinoma after radiotherapy.MethodsThe eustachian tube dysfunction score, pure tone air conduction threshold, bone conduction threshold, the score of tympanogram and otoscope were prospectively observed in patients with deafness after radiotherapy only or combined radiotherapy and chemotherapy for nasopharyngeal carcinoma. Paired t test and one-way analysis of variance were used to analyze the data before and after treatment.ResultsA total of 17 patients were observed. The median time from radiotherapy to now was 228 months, and the median time from the diagnose of deafness to now was 92 months. After 4 weeks of hydrogen inhalation, the score of eustachian tube dysfunction, air conduction and bone conduction hearing thresholds were significantly reduced, P values were 0.0293, 0.0027, 0.0404, respectively. The mean air-bone gap, the score of otoendoscopy and tympanogram were also decreased, but the differences were not significant (P = 0.2079, P = 0.0536, P = 0.1056). Patients with radiotherapy alone and concurrent chemo-radiotherapy had significantly lower air conduction hearing threshold after hydrogen absorption (P = 0.0142, P = 0.0495). The results of air and bone hearing thresholds before, 4 and 12 weeks after hydrogen inhalation showed a descending trend. The air and bone hearing thresholds before hydrogen inhalation were 74.69 ± 27.03 dB and 45.70 ± 21.58 dB, respectively. At the 12th week, the mean values of air and bone hearing thresholds were the lowest, which were 66.88 ± 20.88 dB and 40.94 ± 18.93 dB, respectively, but there was no significant difference in air and bone hearing thresholds among all groups (P = 0.6755, P = 0.7712). After hydrogen inhalation treatment, no adverse reactions such as nosebleed, chest pain, dyspnea, nausea, vomiting, dizziness, earache and allergic reaction were observed.ConclusionThis is the first prospective study on the effect of hydrogen inhalation on hearing improvement in patients with deafness after radiotherapy/chemotherapy for nasopharyngeal carcinoma, suggesting that continuous hydrogen inhalation may be an alternative rehabilitation therapy for these patients.

Compare the Outcomes of Underlay and Onlay Myringoplasty

Objective: The purpose of this study is to compare the outcomes of myringoplasty patients who had underlay and onlay procedures in order to establish whether approach is superior. Study Design: Quasi-experimental study Place and Duration: The study was conducted at the department of ENT, Head &amp;Neck Surgery, Lady Reading Hospital MTI Peshawar and Chaudhary Muhammad Akram Teaching and Research Hospital Lahore for the period from May 2021 to October 2021. Methods: This study included a total of 114 patients ranging in age from 14 to 60 years. After obtaining informed written consent, patients' full details including age, gender and BMI were recorded. Chronic otitis media and/or trauma-related tympanic membrane perforation was included. M and N were the designations given to the two sets of patients. 57 patients in Group M received underlay myringoplasty and 57 patients in Group N underwent for onlay myringoplasty respectively. The success rate of grafts was evaluated for both groups. A three-month period was allotted for complete follow-up in both groups. SPSS 24.0 was used to analyze all of the data. Results: Group M had 38 (66.7%) males, but group N had 42 (71.9%) males. There were 26.13±5.39 years and 27.10±3.42 years were the mean ages of the two groups, respectively, for group M and group N. There were 53 (93%) graft successes in group M and 49 (86%) in group N. Group M's medialization was 5.3%, but group N's medialization was 10.5%, with no evidence of lateralization in either group. Mean air bone gap closure was 8.1±4.33 dB in group M and 10.9±7.61 dB in group N. Conclusion: After doing this research, we came to the conclusion that the underlay technique for myringoplasty was more beneficial in terms of graft success and hearing restoration. Overall, both groups had accepted success rate, which is comparable to the national average. Keywords: Myringoplasty, Overlay technique, Underlay technique, Graft success

Automatic Prediction of Conductive Hearing Loss Using Video Pneumatic Otoscopy and Deep Learning Algorithm.

Diseases of the middle ear can interfere with normal sound transmission, which results in conductive hearing loss. Since video pneumatic otoscopy (VPO) findings reveal not only the presence of middle ear effusions but also dynamic movements of the tympanic membrane and part of the ossicles, analyzing VPO images was expected to be useful in predicting the presence of middle ear transmission problems. Using a convolutional neural network (CNN), a deep neural network implementing computer vision, this preliminary study aimed to create a deep learning model that detects the presence of an air-bone gap, conductive component of hearing loss, by analyzing VPO findings. The medical records of adult patients who underwent VPO tests and pure-tone audiometry (PTA) on the same day were reviewed for enrollment. Conductive hearing loss was defined as an average air-bone gap of more than 10 dB at 0.5, 1, 2, and 4 kHz on PTA. Two significant images from the original VPO videos, at the most medial position on positive pressure and the most laterally displaced position on negative pressure, were used for the analysis. Applying multi-column CNN architectures with individual backbones of pretrained CNN versions, the performance of each model was evaluated and compared for Inception-v3, VGG-16 or ResNet-50. The diagnostic accuracy predicting the presence of conductive component of hearing loss of the selected deep learning algorithm used was compared with experienced otologists. The conductive hearing loss group consisted of 57 cases (mean air-bone gap = 25 ± 8 dB): 21 ears with effusion, 14 ears with malleus-incus fixation, 15 ears with stapes fixation including otosclerosis, one ear with a loose incus-stapes joint, 3 cases with adhesive otitis media, and 3 ears with middle ear masses including congenital cholesteatoma. The control group consisted of 76 cases with normal hearing thresholds without air-bone gaps. A total of 1130 original images including repeated measurements were obtained for the analysis. Of the various network architectures designed, the best was to feed each of the images into the individual backbones of Inception-v3 (three-column architecture) and concatenate the feature maps after the last convolutional layer from each column. In the selected model, the average performance of 10-fold cross-validation in predicting conductive hearing loss was 0.972 mean areas under the curve (mAUC), 91.6% sensitivity, 96.0% specificity, 94.4% positive predictive value, 93.9% negative predictive value, and 94.1% accuracy, which was superior to that of experienced otologists, whose performance had 0.773 mAUC and 79.0% accuracy on average. The algorithm detected over 85% of cases with stapes fixations or ossicular chain problems other than malleus-incus fixations. Visualization of the region of interest in the deep learning model revealed that the algorithm made decisions generally based on findings in the malleus and nearby tympanic membrane. In this preliminary study, the deep learning algorithm created to analyze VPO images successfully detected the presence of conductive hearing losses caused by middle ear effusion, ossicular fixation, otosclerosis, and adhesive otitis media. Interpretation of VPO using the deep learning algorithm showed promise as a diagnostic tool to differentiate conductive hearing loss from sensorineural hearing loss, which would be especially useful for patients with poor cooperation.

Clinical Usefulness of Simple Underlay Myringoplasty

Background and Objectives Recently, myringoplasty, which does not require elevation of tympanomeatal flap, has drawn attention again as a minimally invasive surgery. This study assessed clinical usefulness of simple underlay myringoplasty in repairing dry perforated eardrum or chronic suppurative otitis media in aged and/or frail patients.Subjects and Method This retrospective study included patients who underwent simple underlay myringoplasty from February 1, 2017 to September 30, 2020, and who were monitored for more than 6 months after surgery. Major outcome measurements were determined by graft success and hearing results.Results A total of 106 cases were studied. The overall graft success rate was 84.0% and the mean air-bone gap decreased by 7.8 dB postoperatively. The graft take was quite successful even in the cases of recurrent or chronic otorrhea in aged (≥70 years old) and/or frail patients.Conclusion Simple underlay myringoplasty could be used as a minimally invasive surgery in dry perforated eardrum. It could be also considered as the first surgical choice for recurrent or chronic otorrhea in chronic suppurative otitis media in aged and/or frail patients.

Ossicular Chain Status in Adults with Chronic Otitis Media Mucosal at a Tertiary Referral Hospital in Nepal

Introduction&#x0D; Chronic Otitis Media (COM) is a common condition characterized by perforation of the tympanic membrane and inflammation of middle ear cleft mucosal lining for at least 2-6 weeks. This study was carried out to find out the status of the middle ear ossicles in patients with COM mucosal and to correlate with clinical parameters.&#x0D; Materials and Methods&#x0D; This retrospective clinical study comprises 106 myringoplasty patients at the department of ENT, Shree Birendra Hospital. Their preoperative PTA, four frequencies (500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz) Air Conduction Thresholds (ACT), and Air Bone Gap (ABG) were recorded. Ossicular chain integrity and mobility evaluated intraoperatively were noted. Ossicular chain status was analyzed with ACT and ABG.&#x0D; Results&#x0D; The ossicles were intact and mobile in 91.5%, either fixed/ restricted or disrupted in 8.5%. Mean ACT and ABG comparisons in intact and ossicular chain defect groups were statistically significant. Frequency-specific ACT at all four frequencies and ABG except at 4000 Hz in the two groups were also statistically significant to predict the ossicular involvement. The group with ossicular defect had moderate to severe Conductive Hearing Loss (CHL).&#x0D; Conclusion&#x0D; Mean as well as frequency-specific ACT and ABG can be considered as a potential preoperative predictor for ossicular chain status in COM mucosal.

Comparison ofendoscopic over-underlay technique with and without packing forrepairing chronic perforation.

This study was performed to compare the efficacy of the endoscopic modified cartilage over-underlay technique with and without packing for repairing chronic tympanic membrane (TM) perforations. A total of 70 cases of chronic TM perforation were randomly allocated to endoscopic modified cartilage over-underlay myringoplasty groups with (n = 35) and without (n = 35) packing. The graft success rate and hearing outcomes were compared between the two groups. In addition, neovascularization scores were subjectively obtained. At 12months postoperatively, the difference in graft success rate between the packing and no-packing groups was not significant (94.3% vs. 100.0%, P = 0.473). In addition, there were no significant differences between the two groups in the pre- or postoperative air-bone gap (ABG) (15.18 ± 2.73 vs. 15.07 ± 4.02, P = 0.623 and 8.63 ± 3.03 vs. 8.52 ± 4.50, P = 0.591) or mean ABG gain (6.56 ± 3.23 vs. 6.54 ± 2.83, P = 0.751). However, the average operating times were 43.6 ± 7.1 and 32.7 ± 2.1min in the packing and no-packing groups, respectively (P < 0.001). Surgical and hearing outcomes were comparable between patients with chronic TM perforation treated using the endoscopic modified over-underlay technique with and without packing. However, without packing, the procedure was less invasive and had a shorter operating time.

Efficacy of autologous platelet-rich plasma on graft uptake in myringoplasty: a single-blinded randomized control trial

Background and aimChronic otitis media is defined as a chronic inflammation of the middle ear cleft producing irreversible pathological changes. The myringoplasty aims at the reconstruction of the tympanic membrane using a graft material. Autologous platelet-rich plasma can be used along with the graft to have a successful outcome. The aim of the study was to assess the efficacy of autologous platelet-rich plasma on graft uptake in myringoplasty.MethodsThis was a randomized controlled trial with a sample size of 76 patients. All patients were above 18 and below 55 years of age diagnosed with chronic suppurative otitis media and were planned for myringoplasty. The participants were randomly allotted to two groups by block randomization (block of 4). Intra-operatively, group I (n=38) received platelet-rich plasma–soaked gel foam and group II (n=38) was taken as the control group who received saline-soaked gel foam and examined by a blinded examiner at the end of 1st and 3rd months.ResultsThe mean air-bone gap reduction post-operatively in the platelet-rich plasma group was 8.68 ± 4.8 (P value 0.034) and 6.05 ± 4.05 in the control group. The improvement in pure-tone average in the platelet-rich plasma group (P = 0.009) is more than that in the control group. The graft uptake was higher among the platelet-rich plasma group than the control group both at 1st and 3rd months (P value 0.049) which were statistically significant.ConclusionThe present study concludes that the usage of platelet-rich plasma in the conventional myringoplasty technique has improved the success rate of graft uptake and reduced the graft migration.Trial registrationClinical Trials Registry-India (ICMR-NIMS) CTRI/2020/04/024416. Date of registration: 01/04/2020. Date of enrolment of the first participant to the trial: 06/04/2020. URL of the trial registry: http://www.ctri.nic.in.HighlightsUsage of autologous platelet-rich plasma (PRP) in conventional myringoplasty in underlay technique.Assessment of graft uptake, percentage of perforation closure, and the audiological outcome.Significant mean reduction of ABG in the PRP group.Significant improvement in PTA average in the PRP group.Graft uptake and percentage of perforation closure were higher in the PRP group and the control group.PRP is also beneficial in revision cases.

Tympanic membrane perforations: the importance of etiology, size and location.

The ability to predict the degree of a conductive hearing loss caused by a tympanic membrane perforation is important for every otologist, as it may require additional diagnostic tests and prevent unexpected intraoperative findings. The aim of this study was to correlate the various characteristics of a perforation (etiology, size, location, involvement of the manubrium or umbo) with the degree and frequency predominance of the consequent hearing loss. A transversal study in a tertiary hospital center was conducted between July 2019 and December 2020. Fifty-eight patients with 65 tympanic perforations underwent a comprehensive medical and audiological evaluation, which included an otoendoscopy. An image processing software (ImageJ®) was used to measure the perforated area. The qualitative variables were etiology, affected quadrants, presence of myringosclerosis and involvement of umbo or manubrium of the malleus. The air-bone gap was measured at 250, 500, 1000, 2000 and 4000Hz. Primary outcomes (mean air-bone gap and pure-tone average) were evaluated to find clinical factors associated with worse hearing. Data collected from 50 ears was included. Perforation size showed a positive statistically significant correlation with the air-bone gap (r = .508; p < .001) and pure-tone average (r = .375; p < .001). Higher air-bone gaps were found in perforations involving the posterior quadrants and the manubrium (p < .001 and p = .031, respectively). Inflammatory causes showed higher bone and air conduction pure-tone averages (p = .031 and p = .084, respectively) compared to traumatic or iatrogenic. An "inverted V" pattern of the air-bone gap, with the 2kHz frequency being the least affected, was a consistent finding. However, it was not due to the Carhart's notch in bone conduction. The conductive hearing loss resulting from a tympanic membrane perforation is etiology, size and location-dependent, with higher losses occurring for inflammatory backgrounds, large perforations and when the posterior quadrants or the manubrium are involved. If the "inverted V" is absent, additional middle ear pathology should be investigated.

ENDOSCOPIC EAR SURGERY IN CROATIA - INITIAL RESULTS OF TOTAL ENDOSCOPIC TRANSCANAL MYRINGOPLASTY.

The aim of this study was to show clinical outcome in 56 patients with tympanic membrane perforation operated on by total endoscopic transcanal myringoplasty. Out of the total of 74 patients operated on exclusively endoscopically, we identified 56 patients in whom tympanoplasty type I (myringoplasty) was performed. In 43 patients (45 ears), myringoplasty was performed in a standard transcanal fashion with lifting of the tympanomeatal flap, and in 13 patient butterfly myringoplasty was performed. The size and position of perforation, surgery duration, hearing status and closure of the perforation were evaluated. Perforation closure was obtained in 50 of 58 ears (86.21%). The mean surgery duration was 62.69±22.56 minutes in both groups. Hearing improved significantly, with the preoperative mean air-bone gap of 20.41±9.29 dB improving to the postoperative mean air-bone gap of 9.05±7.77 dB. No major complications were recorded. Our results of graft success rate and hearing outcomes are comparable with those of microscopic myringoplasties but without the need for external incisions and with reduced surgical morbidity. Hence, we recommend total endoscopic transcanal myringoplasty as the method of choice for tympanic membrane perforation regardless of its size and location.

Congenital Aural Stenosis With Cholesteatoma.

Compare surgical and audiological outcomes of patients with congenital aural stenosis (CAS) with cholesteatoma to patients with CAS without cholesteatoma and patients with complete congenital aural atresia (CCAA). Retrospective case series. Tertiary care hospital. Patients with CAS (with and without cholesteatoma) and CCAA. Surgery for CAS/CAA. Patients with CAS and CAA undergoing surgical repair from June 2004 to July 2020 were identified from an institutional database. Included patients were divided by presence of a canal cholesteatoma. Clinical history, pre- and postoperative audiometric data, and clinical outcomes were compared. Of the 283 patients (300 ears), 18 (19 ears) had a canal cholesteatoma. When compared to ears without cholesteatoma (CCAA ears plus CAS ears without cholesteatoma), ears with cholesteatoma were more likely to be younger (9.2 ± 6.6 vs. 11.5 ± 9.2; p = 0.015), female (66.7% vs. 38.1%; p = 0.02; OR 3.2, 95% CI 1.18-8.9), and have normal/Grade I microtia (47.4% vs. 9.6%; p < 0.0001; OR 0.12, 95% CI 0.044-0.32), but not a history of draining ear (5.3% vs. 0%; p = 0.05; OR 0.06, 95% CI 0.004-0.999). Preoperative audiometric data demonstrated a lower mean air-bone gap (45.8 dB vs. 52.3 dB; p = 0.009) and better speech reception threshold (48.7 dB vs. 57.4 dB; p = 0.0004) in cholesteatoma ears. Postoperatively, ears with cholesteatoma were more likely to close the ABG within 20 dB (p = 0.001; OR 0.19, 95% CI 0.072-0.52). No patient in the cholesteatoma group developed post-operative bony/soft-tissue stenosis (0% vs. 9.7%; p = 0.65; OR 1.61; 0.21-12.6) or required revision surgery (0% vs. 11%; p = 0.38; OR 2.46, 0.32-19). Patients with CAS and cholesteatoma have better audiometric outcomes and likely a more durable repair with a decreased need for revision possibly secondary to greater embryologic development of the meatus, ear canal, and middle ear space despite the cholesteatoma.

Revision Stapes Surgery: Hearing Symptoms and Associations With Intraoperative Findings and Outcomes.

Stapes surgery for otosclerosis occasionally requires revision due to recurrent or persistent conductive hearing loss (CHL). This study examines outcomes after revision stapes surgery. Retrospective review. Single tertiary neurotology center. Patients undergoing revision stapes surgery for otosclerosis from 2008 to 2017 were reviewed. Postoperative air-bone gaps (ABGs) were the primary outcome measure. During the study period, 150 patients underwent revision stapes surgery. One hundred patients (67%) had gradually progressive recurrent CHL; 16 (11%), sudden recurrent CHL; 13 (9%), persistent CHL; and 21 (14%), no CHL. For 129 patients with CHL, the mean ABG improved from 23.7 to 9.3 dB (P < .0005). The most common intraoperative findings for these patients were prosthesis displacement with incus necrosis (38%) or without it (43%), normal anatomy with seemingly good prosthesis placement (6%), and abundant scar tissue (6%). Patients with recurrent hearing loss achieved lower mean ABGs than patients with persistent hearing loss (8.8 vs 13.2 dB, P = .02). There were no associations between onset pattern of CHL or intraoperative findings and hearing outcomes (P > .05). Four patients (2.7%) developed sensorineural hearing loss after revision, defined as an increase in bone conduction pure tone average ≥15 dB, all of whom had previous replacement of a malpositioned prosthesis. Revision stapes surgery confers significant improvement in hearing for patients with persistent and recurrent CHL, although patients with persistent CHL after initial surgery see less improvement with revision.

Outcomes following tympanoplasty surgery using porcine-derived small intestinal submucosa.

To determine the outcomes of tympanoplasty surgery using porcine-derived small intestinal submucosa. A retrospective audit was conducted in a hospital setting. Thirty-five adult and paediatric patients who received a small intestinal submucosa graft as part of tympanoplasty surgery were retrospectively reviewed. Patients underwent either simple tympanoplasty (n = 26) or complex tympanoplasty as part of a concurrent otological procedure such as atticotomy and mastoidectomy. The main outcome measures were rate of tympanic membrane closure and change in four-frequency mean air-bone gap. Thirty-one patients had a follow-up period of longer than two months. Closure was obtained in 22 patients (71 per cent). The mean air-bone gap improved from 20.7 to 12.3 dB HL in the simple tympanoplasty group and from 22.3 to 12 dB HL in the complex tympanoplasty group. Tympanoplasty surgery with small intestinal submucosa is a viable option for patients where autologous graft is not available or in order to minimise donor site morbidity.

Comparison of Surgical Outcome of Endoscopic with Microscopic Type I Tympanoplasty in Chronic Otitis Media: A Randomized Controlled Trial.

Aim of the study was to compare the surgical outcome of endoscopic with microscopic Type 1 tympanoplasty in dry, mucosal type of chronic otitis media with respect to graft uptake rate, hearing gain and duration of surgery. This randomized controlled trial of 3 years was carried out at Tertiary Care Hospital of Central India. Total 80 cases of mucosal type of chronic otitis media posted for Type I tympanoplasty were included in the study. They were randomly divided into two groups viz. Endoscopic tympanoplasty and microscopic tympanoplasty with 40 patients in each group. Chi-square test was used to compare the qualitative results and student's t-test was used to compare quantitative results with a level of significance of p ≤ 0.05. Intraoperatively, widening of external auditory canal and auxiliary incision were required in 45% and 47.5% patients of microscopic group respectively. Mean operative time for endoscopic tympanoplasty (62.5 ±14.94mins) was less as compared to microscopic tympanoplasty (74.88 ± 15.83mins). Graft uptake rate was 95% and 92.5% in endoscopic and microscopic tympanoplasty groups respectively with statistically insignificant difference (p=0.32). The preoperative mean air bone gap in both the groups was improved significantly 6 months postoperatively. Air bone gap closure was of 13.21± 4.37dB in endoscopic group and 12.54± 4.14dB in microscopic group with statistically insignificant difference. Endoscope provides superior visualization of hidden areas of middle ear cavity and has shorter operative time than microscopic tympanoplasty with comparable surgical and functional outcomes. hence endoscopic tympanoplasty can be a good option to microscopic surgery.

Tinnitus and Otosclerosis: An Exploratory Study about the Prevalence, Features and Impact in Daily Life.

Introduction Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. Objective To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Methods Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). Results In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. Conclusion The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.

Outcomes of Canal Wall Down Mastoidectomy following Type III Tympanoplasty

Objectives: To see the hearing outcomes following Type III tympanoplasty with stapes columella grafting after canal wall down mastoidectomy and find out the recurrence rates in patients undergoing this procedure. Methods: This prospective observational study includes 120 cases undergoing Type III tympanoplasty with stapes columella grafting following canal wall down mastoidectomy for cholesteatoma at a tertiary care center from 2018 to 2020. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if they were found to have undergone the aforementioned procedure. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 6 months and 1 year postoperatively. Results: One hundred and twenty patients were included for this study. Erosion of the otic capsule, posterior fossa plate, or tegmen was noted in 20% of cases, highlighting disease severity. One hundred and two (85%) had undergone prior otologic surgery. Mean time to short-term follow-up was 6 ± 3 months. The average short-term ABG was 25 ± 12 dB HL; 36% achieved an ABG &lt;20 dB and thirteen had follow-up at least 1 year postoperatively (mean = 33 ± 16 months). At longer-term follow-up, mean ABG was 24 ± 11 dB HL. Hearing remained stable over time (P = .26). Conclusion: In some patients undergoing canal wall down mastoidectomy for advanced or recurrent cholesteatoma, Type III tympanoplasty with stapes columella grafting yields marginal hearing benefit. Bangladesh J Otorhinolaryngol 2021; 27(2): 145-151

Surgical Outcomes of Pure-Fat Myringoplasty for Small Tympanic Membrane Perforations: A Retrospective Study and Summary of the Literature in the Last 10 Years

Background and Objectives Fat myringoplasty is a simple, fast, and effective procedure for repairing tympanic membrane (TM) perforations. The aim of this study is to evaluate the surgical outcomes of pure-fat myringoplasty for small TM perforations at our hospital and review the current knowledge regarding fat myringoplasty, with consideration of the effectiveness of additional substances used in the treatment of small TM perforations.Subjects and Method We retrospectively studied 41 patients who underwent pure-fat myringoplasty at our hospital from March 2008 through April 2019 and were followed up for at least 2 months thereafter.Results Of 41 patients, 16 were males and 25 were females, with the mean age of 48 (male, 9-75 years; female, 16-65 years). All perforations were classified as small perforations, ranging from 1% to 17% of the TM. The overall success rate was 92.7%, with the TMs of 3 patients (7.3%) failing to close. Air-bone gap (ABG) decreased in 19 out of 24 patients who underwent both preoperative and postoperative pure tone audiometric examinations. The mean ABG was 4.42 dB (n=24; paired-t test, &lt;i&gt;p&lt;/i&gt;=0.001; 95% confidence interval, 1.77-7.07). The literature review revealed that TM closure success rate of over 80% was associated with pure-fat myringoplasty, while the TM closure success rate for fat myringoplasty with additional substances was 85% to 100%.Conclusion Our study revealed a high TM closure success rate and good hearing outcomes are associated with pure-fat myringoplasty. Pure-fat myringoplasty seems to be sufficient for repairing small TM perforations.

OUTCOMES OF CIRCUMFERENTIAL V/S ANTERIOR TUCKING TYMPANOPLASTY TECHNIQUE IN INACTIVE MUCOSAL CHRONIC OTITIS MEDIA WITH SUBTOTAL PERFORATIONS: A PROSPECTIVE OBSERVATIONAL STUDY

Objective: The objective of the study is to compare circumferential versus anterior tucking underlay tympanoplasty technique. Methods: In this prospective observational study, 100 patients with chronic otitis media (Inactive mucosal type) were included, who were randomly allocated in two groups; Group I which comprised of 50 patients in which tympanoplasty with anterior tucking was done, and Group II comprised of 50 patients in which circumferential flap tympanoplasty was done. Improvement in the hearing gain and graft uptake success rate was compared. Results: The mean air-bone gap (ABG) changed from 28.74 dB to 11.52 dB after anterior tucking with a mean change of 17.22 dB and this change was found to be statistically significant (p&lt;0.001). Similarly, the mean ABG changed from 28.92 dB to 11.86 dB after a circumferential flap with a mean change of 17.06 dB and this change was also found to be statistically significant (p&lt;0.001). There was a slightly better improvement (17.22 dB) in the anterior tucking group as compared to the circumferential flap (17.06 dB). This difference was, however, not found to be statistically significant (p=0.830). Three-month graft uptake rate in the anterior tucking group was found 92% and in the circumferential group was 94%. (p&gt;0.05). Conclusions: Our study concluded that both techniques have almost the same results with good graft uptake. Results of hearing improvements in both techniques were also comparable.

Compare the Outcomes of Underlay and Onlay Myringoplasty

Objective: To determine the outcomes between underlay and onlay techniques underwent myringoplasty. Study Design: Quasi-experimental study. Place and Duration of Study: Department of ENT, Nowshera medical College/Qazi Hussain Ahmad Medical Complex, Nowshera from 1st July 2018 to 30th June 2020. Methodology: One hundred patients with age ranges 12-55 years were enrolled. Patients details demographics age, sex and body mass index were recorded after taking informed written consent. Patients suffered with tympanic membrane perforation related to chronic otitis media and/or trauma were included. They were divided into two groups, I and II. Group I had 50 patients and received underlay myringoplasty and group II had 50 patients underwent for onlay myringoplasty. Outcomes among both groups were assessed in terms of graft success rate. Complete follow-up among both groups was taken in duration of 4 months. Results: There were 35 (70%) males and 15 (30%) females in group I while in group II 30 (60%) males and 20 (40%) females. Mean age in group I was 24.15±8.41 years with mean BMI 25.17±6.53 kg/m2 and in group II mean age was 25.15±8.41 years with mean BMI 25.21±6.14 kg/m2. In group I graft success rate was 48 (96%) and in group II 45 (90%) graft success found. Medialization in group I was 2 (4%) and in group II was 4 (8%) and no any lateralization was found in both groups. Hearing was improved in group I, mean air bone gap closure was 9.8±6.45dB and in group II 11.8±4.54 dB. Conclusion: The underlay technique for myringoplasty was more effective in terms of graft success and hearing improvement. Overall success rate among both groups was 93% among both groups. Keywords: Underlay technique, Overlay technique, Myringoplasty