Mean Preoperative Air-bone Gap Research Articles

Success rates in restoring hearing loss in patients with chronic otitis media: A systematic review.

ObjectiveTo assess the effectiveness of tympanoplasty in treating chronic otitis media‐related hearing loss, published literature was systematically reviewed to determine the clinical success rate of tympanoplasty at restoring hearing in chronic otitis media patients at a minimum follow‐up period of 12‐months.Data SourcesPubMed, Embase and the Cochrane Library.MethodsTwo independent reviewers performed literature searches. Publications reporting long‐term (≥12‐month) hearing outcomes and complications data on adult and pediatric patients with chronic otitis media were included and assessed for risk of bias and strength of evidence. To assess how tympanoplasty influences long‐term hearing outcomes, data on pure tone audiometry (air‐bone gap) and complications were extracted and synthesized.ResultsThirty‐nine studies met the inclusion criteria. Data from 3162 patients indicated that 14.0% of patients encountered postoperative complications. In adult patients, mean weighted air‐bone gap data show closure from 26.5 dB hearing level (HL) (preoperatively) to 16.1 dB HL (postoperatively). In studies that presented combined adult and pediatric data, the mean preoperative air‐bone gap of 26.7 dB HL was closed to 15.4 dB HL. In 1370 patients with synthesizable data, 70.7% of patients had a postoperative air‐bone gap ˂ 20 dB HL at long‐term follow‐up. Finally, subgroup analysis identified that mean improvement in ABG closure for patients with and without cholesteatoma was 10.0 dB HL and 12.4 dB HL, respectively.ConclusionIn patients with chronic otitis media, tympanoplasty successfully closed the air‐bone gap to within 20 dB HL in 7/10 cases and had an overall complication rate of 14.0%.Level of Evidence2a.

Comparative analysis of titanium clip prostheses for partial ossiculoplasty

ObjectivesThe aim of our study was to perform a comparative analysis in our cases with titanium partial clip ossiculoplasty in terms of audiometric outcome and extrusion rates as well as to review the literature for relevant information on this surgical issue. Materials and methodsThe records of all patients who had undergone primary partial ossiculoplasty with the implantation of a CliP® Partial Prosthesis Dresden Type (CPPDT, group A) or a CliP Partial FlexiBAL® (CPF, Group B, both Heinz Kurz GmbH, Dusslingen, Germany) between 2012 and 2020 were studied retrospectively. Results274 patients made up our study sample (148 men, 126 women, male to female ratio: 1.17). Their mean age at the time of first surgery was 39.6 years (range: 4–79 years). The mean preoperative air-bone gap (ABG) was 22.7dΒ ± 10.5 dB. Mean follow-up was approximately 4 months (1–12 months). The mean postoperative ABG was 15.7 ± 8.1 dB. In total, the postoperative ABG was significantly improved compared to preoperative values (P < 0.001). Surgical success, defined as an ABG ≤ 20 dB, was achieved in the majority of our study patients (210/274, 76.6%). Extrusion of the prosthesis was detected in 3/216 CPF and 5/58 CPPDT cases (p = 0.012). Comparison of both prosthesis groups revealed a significantly better audiological outcome for the patients with ossicular reconstruction using CPF. A significantly better audiological outcome was detected in the cases with a normal aeration of the middle ear. DiscussionTitanium clip partial ossiculoplasty is a reliable component of modern tympanoplasty, allowing a satisfying audiologic outcome. The higher adaptability of the CPF to the changing postoperative circumstances and the frequently defective aeration of the middle ear is reflected in the better audiologic outcome for this prosthesis.

Postinflammatory Medial Meatal Fibrosis: Histopathologic Features and Outcomes of Surgical Management.

The aims of our study were to investigate the clinical and audiometric outcome of the surgical treatment of postinflammatory medial meatal fibrosis (PIMMF) and to review the histopathologic changes in the specimens of the fibrotic plug, in order to try to shed light on the pathogenesis of the disease. The clinical records and the histopathologic specimens of all patients who underwent tympanomeatoplasty for PIMMF at the ENT Clinic of the University of Erlangen between 2006 and 2020 were evaluated retrospectively. Thirty-four patients (41 primary surgical procedures) made up our study cohort. Of this, 28 cases were managed by means of meatoplasty and 13 cases with tympanomeatoplasty. The mean preoperative air-bone gap (ABG) was 27.8 dB (10-44 dB). Postoperative ABG was significantly improved compared to preoperative values at both short- and long-term follow-ups (P < .001 for both). No significant difference was noted between short-term and long-term ABG (P = .240). An ABG ≤20 dB was achieved in 65.8% of patients (short term) and 50% (long term). The overall rate of revision surgery for restenosis was 29.3% (12/41). Histopathologic reevaluation of the fibrotic plugs revealed a mosaic of patterns with frequent occurrence of secondary cholesteatoma-like lesions and keloid-like tissue changes. Lichenoid submucosal inflammation and increased ectopic ceruminous gland lobules were seen less frequently. The moderate long-term outcome of surgical management and the identification of histologic changes with therapeutic implications might pave the way for alternative nonsurgical treatment options.

Hydroxyapatite bone cement in the reconstruction of defects of the long process of the incus: Personal experience and literature review

ObjectiveErosion of the long process of the incus is the most common ossicular chain pathology occurring in the course of chronic middle ear disease. The aim of this study was to evaluate our experience in the reconstruction of short-length defects of the long process of the incus using hydroxyapatite bone cement over a period of 15 years. MethodsThe medical records of all patients treated with hydroxyapatite bone cement for an isolated short-length erosion of the long process of the incus or the lenticular process at an academic tertiary referral center between 2005 and 2019 were studied retrospectively. Results48 patients made up our study sample (19 men, 29 women). The mean age at the time of surgery was 38.1 years. The mean preoperative air-bone gap (ABG) was 21.36 dB. The mean postoperative ABG was 15.89 dB within 8 weeks of surgery and 11.81 dB at least 6 months after surgery. The postoperative ABG had significantly improved compared to preoperative ABG values at both the short- and middle-term follow-up (p < 0.001 for both). An ABG ≤ 20 dB was achieved in 68% in the short term and 83% in the middle term. The mean ABG in the long term (< 12 months) was 11.1 dB. ConclusionRestoration of the anatomic and functional continuity of the ossicular chain using hydroxyapatite cement in defects of the long process of the incus seems to warrant a satisfactory audiologic outcome in the majority of cases.

Study on outcome of tympanopanoplasty: a two year institutional study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tympanoplasty is one of the common surgical procedure performed in CSOM (TTD), this study was undertaken to determine the outcome of tympanoplasty at a tertiary care teaching hospital.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This analytical observational study was conducted in the department of E.N.T, School of Medical Sciences and Research, from January 2017 to December 2018. Informed consent was taken to participate in the study pure tone audiometry (PTA) was performed before surgery and post-operatively six months. Air-bone gap (ABG) was calculated in pre- and postoperative PTA. The data were analyzed using SPSS (version 20). The p value ≤0.05 was considered statistically significant. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Over a peroid of 2 years 168 patients underwent type 1 tympanoplasty 86 were male 21 (51.19%), female 82 (48.80%), age (range 15–53 years). Mean pre-operative air-conduction of 43.12 dB was significantly reduced to 16.12 dB with p value of &amp;lt;0.05. Similarly the pre-operative mean air bone gap on PTA of 35.63±6.35 dB was also reduced to statistically significant level of 7.41±3.51 dB on post-operative PTA with p value of &amp;lt;0.05. Graft was taken up well in 152 cases (90.2%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; According to our study surgical outcome of tympanoplasty is fairly good and should be done if patient gives consent.&lt;/p&gt;

Prospective study of use of Island of tragal cartilage in revision tympanoplasty

Background: Ideal graft material in revision tympanoplasty is a topic of much research. Cartilage being sturdy and stable even in negative pressure situations, is a viable option. Aims and Objectives: The aim of the present study was to evaluate graft uptake and hearing improvement using the technique of island of tragal cartilage as a graft material in revision tympanoplasty. Materials and Methods: This was a prospective study of total of 60 Type 1 revision tympanoplasty surgeries which were done using tragal cartilage island graft from December 2017 to December 2019 in our institute with a follow-up of 3 months. Results: Graft uptake in our study was found to be 93.33%. Four patients showed a re-perforation during follow-up. The mean preoperative air-bone gap (ABG) was 28.13 dB, while the postoperative mean ABG was 16.83 dB and the mean gain was 12.83 dB. Conclusion: It is thus worthwhile to consider island of tragal cartilage as a graft material in revision tympanoplasty.

To assess the hearing improvement in patients of Chronic Otitis Media Tubotympanic type post tympanoplasty

Aim: To determine hearing improvement in type- 1 tympanoplasty by comparing mean preoperative air bone gap with mean postoperative AB gap. Material and method: Patients clinically diagnosed as 75 cases of Chronic Suppurative Otitis Media Tubotympanic Type Disease presenting to the ENT OPD of Chhatrapati Shivaji Hospital attached to Subharti Medical College, Meerut were taken up for study. Detailed clinical examination and history was taken. Pure tone audiometry was conducted, hearing loss and mean AB Gap was noted pre-operatively. X-Ray mastoid B/L Schuller’s view was done and findings were noted. Tympanoplasty type 1 with or without mastoidectomy was performed. Cortical mastoidectomy with type 1 Tympanoplasty was performed in patients having granulations &amp; polypoidal middle ear mucosa along with sclerotic mastoid. All these patients were followed up post-operatively at 6 weeks. The status of graft uptake was noted. Pure tone audiometry was performed. Hearing loss and mean AB Gap results were compared with pre-operative findings. Results: In our study out of 75 patients, 33 (44%) patients were affected with Right ear and 42 (56%) patients were affected with Left ear. Hearing loss was the chief complaint in all 75 patients (100%) followed by blocking sensation. Post operatively 58 (77.33%) patients had normal hearing followed by 16 (21.33) patients who had mild hearing loss. Only 1 (1.33%) patient had moderately severe hearing loss. Pre-operatively, mean AB Gap was 46.62+/-7.89dB while post-operatively mean AB Gap was 23.43+/-5.52dB with statistically significant difference as p&lt;0.05. Conclusion: In our study, the post-operative Mean AB Gap was improved significantly as compared to preoperative mean AB Gap.

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;

Comparison of the Hearing Results of Total Ossicular Chain Autogenous Mastoid Cortical Bone Ossiculoplasty and Titanium Total Ossicular Replacement Prosthesis in Patients with Cholesteatoma

Background: No studies have investigated the results of ossicular chain reconstruction using mastoid cortical bone ossiculoplasty (MCBO) and titanium total ossicular replacement prosthesis (TiTORP) in Austin-Kartush Group D cholesteatoma patients with severe middle ear risk index (MERI). Objectives: The present study aimed to compare the hearing results of MCBO and TiTORP in Austin-Kartush Group D cholesteatoma patients with severe MERI who underwent ossicular chain reconstruction during primary surgery. Methods: The hearing results of 28 adult cholesteatoma patients who underwent tympanomastoidectomy and ossicular chain reconstruction with MCBO (n=15) or TiTORP (n=13) were analyzed in the current study. The postoperative hearing was tested 12 months after the surgery. The hearing-related functional success rate was determined in accordance with the American Academy of Otolaryngology-Head and Neck Surgery Foundation criteria. Results: When all patients were taken into account, the mean preoperative and postoperative air-bone gaps (ABG) were reported as 32.2 decibel (dB) and 17.6 dB, respectively, (P&lt;0.001). In 57.1% of the patients, the mean postoperative ABG was ≤ 20 dB. The mean preoperative and postoperative ABGs of the MCBO group were obtained at 29.9 and 16.2 dB, while these values were reported as 35.0 and 19.3 dB in the TiTORP group (P=0.001 and P&lt;0.001, respectively). Hearing-related functional success rates were calculated at 60.0% and 53.8% in MCBO and TiTORP groups, respectively, without any significant difference between the groups (P= 0.743). Conclusion: As evidenced by the obtained results, MCBO and TiTORP can provide similar and successful hearing results in Austin-Kartush Group D patients with cholesteatoma; nonetheless, MCBO is a more cost-effective option in this regard.

Efficacy of balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children.

This study aimed to compare the outcomes of ventilation tube insertion and balloon Eustachian tuboplasty as a first line treatment for otitis media with effusion in children. This was a retrospective evaluation of 62 children, 30 cases that underwent balloon Eustachian tuboplasty (group 1) and 32 cases that underwent ventilation tube insertion (group 2), from July 2016 to April 2018. The pre-operative air-bone gap of patients who underwent balloon Eustachian tuboplasty was 15-35 dB (mean: 27.6 ± 8.2 dB). The mean pre-operative air-bone gap decreased to 9.6 dB after a mean of 14.4 months (p < 0.05). The air-bone gap decreased from 25.6 dB to 17.6 dB in the ventilation tube group. There was a significant improvement in the air-bone gap values in both groups; however, this decrease was significantly higher in the balloon Eustachian tuboplasty group (p = 0.043). Balloon Eustachian tuboplasty may be an effective and safe method for use as a first-line treatment of otitis media with effusion in children.

Endoscopic stapes surgery outcomes and complication rates: a systematic review.

These days, the gold standard procedure for otosclerosis treatment is stapes surgery. The endoscopic approach of the procedure is gaining popularity as endoscopic ear surgery develops across the globe. The main objective of this study is to gather and compile well-documented and reliable data regarding surgical outcomes for the endoscopic approach to stapes surgery up to this date. Publications in English were searched in the PUBMED/MEDLINE database and were systematically reviewed. A total of 16 articles were reviewed according to the inclusion criteria, obtaining a total of 573 patients managed surgically for otosclerosis, using an endoscopic approach. Data were systematically extracted and compared across variables. Data were obtained as follows: mean age of 43years; female proportion of 60%; 3mm endoscope diameter of 51%, 4mm of 39%; titanium piston-type prostheses of 52% and Teflon of 48%; length of the prosthesis (mode) was 4.5mm; 0.6mm diameter of the piston of 81% and 0.4mm of 19%; mean surgical time was 55min. Hearing results, mean preoperative air-bone gap (ABG) 31dB; mean postoperative ABG 9dB; ABG improvement of 22dB; an ABG closure rate to 20dB or less of 92% and an ABG closure rate to 10dB or less of 77%. Complication rates: intraoperative tympanic membrane perforation of 5%; postoperative vertigo of 11%; postoperative dysgeusia of 10%; reported a postoperative neurosensorial hearing loss of 0.2%; reported gusher phenomenon of one case (0.2%). Endoscopic stapes surgery is completely achievable using 0º angle and 4-mm-diameter sinus surgery endoscope. Instrument availability should not be an obstacle to the development of this type of surgery in any otolaryngology department. Audiological outcomes are comparable to microscopic approaches.

Malleostapedotomy for otosclerosis, our experience of nitinol piston on twelve patients

ObjectiveMalleostapedotomy allows to completely by-pass the incus in otosclerosis surgery. Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus. However, it remains gold standard for cases of extensive necrosis, incus dislocation, or epitympanic fixation. Modern heat-crimping pistons make surgery easier and safer. This study focuses on our experience with this technique. MethodsRetrospective analysis of patient’s files and pre- and post-operative audiograms, for cases of surgically treated otosclerosis with malleostapedotomy. ResultsTwelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019. Amongst them there were 10 revision surgeries and 2 primary cases. 75% had incus long-process necrosis, 17% had epitympanic fixation and one had a history of incus transposition. Nine patients (75%) had closure of air-bone gap (ABG) of <10 dB (p < 0.001) and 11 (92%) had a threshold of 20 dB (p < 0.001). Mean pre-operative ABG was 31 dB (15 dB–55 dB), and mean post-operative ABG was 7 dB (0 dB–21 dB; p < 0.001). There was no sensorineural hearing loss nor any other post-operative complication. ConclusionsMalleostapedotomy is a safe and reliable technique, allowing an ABG closure comparable to conventional incus to vestibule prosthesis. It remains the preferred technique whenever the incus cannot be used.

Transcanal endoscopic myringoplasty: a retrospective study

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

Laser vs drill for footplate fenestration during stapedotomy: a systematic review and meta-analysis of hearing results.

Stapes surgery is the gold standard surgical treatment nowadays for otosclerosis. Several controversies on the procedure have been reported; surgical techniques for most favorable outcomes are still on discussion. The objective of this study is to present an update of evidence-based medicine concerning the utilization of lasers and drilling for footplate fenestration during stapedotomy surgery. A systematic review and meta-analysis were conducted. Publications in English in the last 5years were searched in the PubMed/MEDLINE database and were systematically reviewed. A total of three articles were included according to the inclusion criteria, obtaining a total of 1531 patients managed surgically for otosclerosis, using laser or drill for footplate fenestration. Data were systematically extracted and hearing results were compared in a meta-analysis. For the drill group, a total of 978 patients were retrieved and data were obtained as follows: mean age was 50years old; the female proportion was 62%; mean preoperative air-bone gap (ABG) of 28dB; mean postoperative ABG of 8dB; mean ABG improvement of 20dB; an ABG closure rate to < 10dB of 74%. For the laser group, a total of 553 patients were retrieved, data were obtained as follows: mean age was 47years old; the female proportion was 63%; preoperative ABG of 26dB; postoperative ABG of 8dB; mean ABG improvement of 18dB; an ABG closure rate to < 10dB of 72%. The results from this study reveal that in regard to postoperative hearing results, surgical outcomes are comparable, and there is no statistically significant difference between the utilization of drills and lasers as a surgical instrument for the fenestration of the stapes footplate during stapedotomy surgery.

Stapes Surgery Outcomes in Patients With Concurrent Otosclerosis and Superior Semicircular Canal Dehiscence.

To review outcomes of stapes surgery in patients with concurrent otosclerosis and superior semicircular canal dehiscence. Retrospective case series. Tertiary referral center. Patients with concurrent otosclerosis and superior canal dehiscence, confirmed by computed tomography (CT) imaging. Stapes surgery for conductive hearing loss. Postoperative air-bone gap (ABG), as well as the number of patients in whom surgery was deemed successful (postoperative ABG <10 dB HL). Five patients with superior canal dehiscence and concomitant otosclerosis who underwent surgical repair were identified. Mean preoperative ABG was 29.0 ± 6.4 dB HL. Mean postoperative ABG was 13.0 ± 13 dB HL. Three patients (60%) had a successful outcome, defined as postoperative ABG less than 10. One patient experienced unmasking of superior canal dehiscence vestibular symptoms. Patients with concurrent otosclerosis and superior canal dehiscence appear to have a lower likelihood of successful hearing restoration following stapes surgery. Patients should be counseled accordingly. Routine preoperative CT imaging before stapes surgery may be helpful to identify patients at risk for poor outcomes.

Use of Mesna in the treatment of ossicular chain fixation related to tympanosclerosis; prospective, clinical study.

Mesna is a thiol compound effective in the connective tissue, which is used for its chemical dissector, mucolytic, mucosal damage preventive and antioxidant effects. The aim of this study was to investigate Mesna's effects in easy dissection in type 4 tympanosclerosis cases and in the prevention of formation of new sclerotic plaques. 11 patients were included in the study. All patients were in the Wielinga Kerr type 4 class of tympanosclerosis. All patients were administered a 100% concentration of Mesna in the middle ear during tympanosclerosis surgery. All patients underwent audiological evaluation before and 20months after the operation. Air-conduction thresholds, bone-conduction thresholds and air-bone difference were statistically compared. The patients were followed-up for a mean 20.48±2.37months. The mean preoperative air-conduction threshold of the patients was 58.09±9.73dB and the mean postoperative air-conduction threshold was 34.63±15.46dB and there was a significant difference. The mean preoperative bone-conduction threshold of the patients was 16.27±5.47dB and the mean postoperative bone-conduction threshold was 14.72±6.11dB and there was a significant difference. The mean preoperative air-bone gap of the patients was 41.81±10.51, and the mean postoperative air-bone gap was 19.90±12.48, and the difference was statistically significant. Mesna prevented hearing loss related to type 4 tympanosclerosis and prevented the formation of new sclerotic structures in our follow-up period. We believe that this effect is due to the chemical dissector and antioxidant effects of Mesna.

Endoscopic Cartilage Butterfly Tympanoplasty: A Two-Handed Technique with Endoscope Holder.

The aim of the study was to evaluate and report the short-term results of two-handed endoscopic cartilage butterfly tympanoplasty using endoscope holders. The efficacy of the operative technique was evaluated and assessed by comparing the air-bone-gap on pure tone audiometry preoperatively and on follow-up at 6months and 1-year post operatively. Patients with uncomplicated otitis media and healthy middle ear status with no ossicular involvement underwent endoscopic transcanal cartilage butterfly tympanoplasty. Small and medium sized tympanic membrane perforations were included in the study. Pre- and postoperative air-bone gaps and presence for any residual perforation was noted. A total 69 patients consisting of 45 males and 24 females with a mean age of 24.45years were included in the study group. Small perforations involving only one quadrant were 39 in number while the medium sized perforations involving two quadrants were 26 in number and the ones involving three quadrants were 4 in number. At the end of the follow-up period of 6months and 1year, successful closure occurred in 67 of 69 patients with a success rate of 97.1%. The mean preoperative Air-Bone gap was 34 ± 3.45dB which showed a steady decline on follow-up at 6months 13 ± 4.53 and 15.34 ± 3.39dB at 1year following surgery. Recurrent perforation was noted in two patients involving three quadrants of the tympanic membrane. Endoscopic two-handed butterfly cartilage tympanoplasty can be safely performed in small and medium sized perforations with no middle ear disease/ossicular involvement. The hearing outcomes and successful closure rate are similar to those of other surgical methods. Our study uses the endoscope which provides superior image quality and the use of an endoscope holder makes the technique a two handed one, thereby making the manoeuvring of the microear instruments easier. Moreover, it can be performed under local anaesthesia with low complication rates and quick recovery. Level of Evidence Level 4.

The evaluation of endoscopic cartilage myringoplasty to repair perforations with otomycosis.

We evaluated the graft success rates and hearing gains of tympanic membrane (TM) perforations with otomycosis undergoing endoscopic cartilage myringoplasty and local applications of antimycotic cream. A prospective case series. In total, 74 persistent perforations with otomycosis who underwent cartilage myringoplasty were included. The pre-, intra-, and post-operative antimycotic cream were applied. The outcomes were the hearing gains and graft take rates at 6months. At 6months, the graft take rate was 83.8% (62/74). 6.8% developed postoperative purulent otorrhea and re-perforations; 9.5% recurrent otomycosis with re-perforations; and 4.1% mild postoperative otorrhea that resolved without re-perforation. The mean preoperative air-bone gap (ABG) was 32.31±5.47dB and the mean postoperative ABG 17.24±4.95dB, thus significantly different (p<.05). Of the 74 patients, 11(14.9%) had ABG closures within 10dB, 48 (64.9%) had closures within 20dB, and 15 (20.3%) had closures within 30dB. We encountered no instances of graft lateralization or significant blunting during follow-up. Endoscopic cartilage myringoplasty effectively treats persistent perforations with otomycosis; however, pre-, intra-, and post-operative local applications of antimycotic cream are recommended.

Endoscopic Cartilage Myringoplasty with Inside Out Elevation of a Tympanomeatal Flap for Repairing Anterior Tympanic Membrane Perforations.

We evaluated the graft take rate and hearing gain of endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap for repairing an anterior tympanic membrane perforation. A retrospective case series. Tertiary university hospital. The study population consisted of patients with an anterior perforation undergoing endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap. The primary outcome was the graft take rate at 6 months. The secondary outcomes were the air-bone gap (ABG) gain at 3 months and complications. A total of 51 patients with a unilateral anterior marginal perforation were included in this study. The mean operation time was 62.2 ± 8.3 minutes. The graft success rate was 92.2% (47/51) at 6 months. The mean preoperative ABG was 28.07 ± 5.13 dB, while the mean postoperative ABG was 12.24 ± 4.89 dB (P < .05). No patients reported sensorineural hearing loss, altered taste, facial nerve palsy, vertigo, or tinnitus. Two patients with a middle perforation developed postoperative purulent otorrhea that resulted in residual perforations. The cartilage graft was extruded into the anterior annulus in two patients with large perforations that resulted in graft lateralization in one patient and residual perforation in the other. Endoscopic cartilage myringoplasty with inside out elevation of a tympanomeatal flap is a useful procedure with a low reperforation rate for repairing anterior perforation.

Endoscopic butterfly inlay myringoplasty: new technique extended perichondrium butterfly

Background: Various graft materials and surgical methods are used in the treatment of tympanic membrane perforations.Aims/Objectives: The aim of this study was to evaluate the operation method and graft success of extended perichondrial butterfly myringoplasty performed by an endoscopic method and the hearing gain of patients.Material and Method: This was a retrospective study evaluating the hearing tests of 54 ears of 48 patients (28 male, 20 female) who underwent surgery between February 2017 and March 2019. Pure-tone audiometric results were analyzed preoperatively and six months postoperatively by recording the perforation size, the duration of surgery, and graft success.Results: The graft success rate was 98.1% (53/54 ears). The perforations were most frequently located in the anterior quadrant and were small-sized. The mean preoperative air-bone gap (ABG) was 17.4 ± 5.24 dB. The mean ABG was 9.2 ± 2.13 dB 1 month postoperatively and 8.5 ± 2.26 dB 6 months postoperatively (p < .005).Conclusions: The endoscopic inlay extended perichondrial butterfly myringoplasty method is safe and doesn’t require tympanomeatal flap elevation. Moreover, it shortens hospitalization time, facilitates anatomical closure of the membrane, and sometimes closes perforations in the anterior part, which cannot be clearly evaluated after graft placement.