Mucosal Type Research Articles

Endoscopic features and treatments of gastric cystica profunda.

Gastric cystica profunda (GCP) represents a rare condition characterized by cystic dilation of gastric glands within the mucosal and/or submucosal layers. GCP is often linked to, or may progress into, early gastric cancer (EGC). To provide a comprehensive evaluation of the endoscopic features of GCP while assessing the efficacy of endoscopic treatment, thereby offering guidance for diagnosis and treatment. This retrospective study involved 104 patients with GCP who underwent endoscopic resection. Alongside demographic and clinical data, regular patient follow-ups were conducted to assess local recurrence. Among the 104 patients diagnosed with GCP who underwent endoscopic resection, 12.5% had a history of previous gastric procedures. The primary site predominantly affected was the cardia (38.5%, n = 40). GCP commonly exhibited intraluminal growth (99%), regular presentation (74.0%), and ulcerative mucosa (61.5%). The leading endoscopic feature was the mucosal lesion type (59.6%, n = 62). The average maximum diameter was 20.9 ± 15.3 mm, with mucosal involvement in 60.6% (n = 63). Procedures lasted 73.9 ± 57.5 min, achieving complete resection in 91.3% (n = 95). Recurrence (4.8%) was managed via either surgical intervention (n = 1) or through endoscopic resection (n = 4). Final pathology confirmed that 59.6% of GCP cases were associated with EGC. Univariate analysis indicated that elderly males were more susceptible to GCP associated with EGC. Conversely, multivariate analysis identified lesion morphology and endoscopic features as significant risk factors. Survival analysis demonstrated no statistically significant difference in recurrence between GCP with and without EGC (P = 0.72). The findings suggested that endoscopic resection might serve as an effective and minimally invasive treatment for GCP with or without EGC.

Role of Topical Estrogen in Outcomes of Myringoplasty: Does it Really Affect the Results of Graft Success and Hearing Thresholds?

The tympanic membrane forms a barrier between the external auditory canal and the middle ear. In the inactive mucosal type of chronic otitis media, there is a perforation in the tympanic membrane which is surgically managed by Myringoplasty. Estrogen as a growth factor has been shown to have a mitogenic effect on keratinocytes thus hastening the rate of epithelialization following injury. This property of estrogen is being studied in this study for its role in the outcomes of myringoplasty. This study was carried out from January 2021 to December 2022 in the Department of Otorhinolaryngology, of a tertiary teaching hospital in North India. Patients were assessed by history, examination, otoscopy, Audiometry, and oto-endoscopy. A total of 88 patients were taken out of which 44 patients underwent myringoplasty in which topical estrogen (estradiol valerate solution) was used, and the remaining 44 patients were taken as controls. Patients were then assessed post-operatively based on Audiometry results and graft uptake status. In the estrogen group successful Graft uptake was in seen 40 (90.9%) patients and failed in 4 (9.1%), while in the control group, it was successful in 37 (84.1%) patients and failed in 7 (15.9%), statistically there was no significant difference between two groups in terms of graft uptake (p value = 0.334). Post-operatively, in the estrogen group, the mean change in Air Conduction (AC) was 15.5dB, the change in the air-bone gap (ABG) was 11.5dB and for Bone Conduction (BC) it was 3.2dB. However, in the control group mean post-operative changes in Air Conduction, Air-Bone Gap, and Bone Conduction were 12dB, 10.7dB, and 0.8dBrespectively. Statistically, there was a significant difference in postoperative changes in AC (p value = 0.011) and BC (p value = 0.009) between the two groups. There was no significant difference in post-operative changes in Air-Bone Gap (p value = 0.571). Topical Estrogen (Estradiol valerate) solution is cost-effective, with enriched growth factors that accelerate tympanic membrane perforation closure following myringoplasty and resulted in significant improvement in hearing thresholds both for Air Conduction and Bone Conduction.

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

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

Survival analysis of comprehensive treatment in Chinese patients with metastatic melanoma: A retrospective analysis.

Most of the current progression of immune checkpoint inhibitors for malignant melanoma is based on data from Caucasians in Western countries, but the benefit of Chinese patients is limited, mainly due to different pathological subtypes. The patients in western countries are mainly skin melanoma (about 90%), while the acral and mucosal types are dominant in China, accounting for 41.8% and 22.6% respectively. Acral and mucosal melanoma have lower response rates to immunotherapy and chemotherapy. Whether immune checkpoint inhibitors can improve the survival of Chinese patients with malignant melanoma, therefore, we conducted a retrospective analysis. We analyzed 53 patients with metastatic melanoma treated in our hospital to evaluate the efficacy and safety of PD-1 mAb in Chinese patients with metastatic melanoma, and performed univariate and multivariate analyses of prognostic factors that may affect overall survival (OS). In a study of 125 patients with advanced malignant melanoma, 53 patients participated, with a median follow-up of 16 months. Among these, 69.8% died, and 30.2% remained on treatment. Median progression-free survival (PFS) was 6 months, and median OS was 19 months. Patients treated with immune checkpoint inhibitors had improved outcomes, with a median PFS of 7 months and a median OS of 24 months. Patients with bone metastasis and aberrant Lactate dehydrogenase (LDH) post-treatment had worse prognoses, while immunotherapy was a protective factor. Subgroup analysis showed the benefits of immunotherapy across various patient characteristics. No unexpected toxicities were observed. The study highlights the efficacy of immune checkpoint inhibitors, particularly PD-1 mAb, in improving survival outcomes for Chinese patients with metastatic melanoma.

Pathophysiology of gastro-oesophageal reflux disease: implications for diagnosis and management.

Gastro-oesophageal reflux disease (GERD) is a common gastrointestinal disorder in which retrograde flow of gastric content into the oesophagus causes uncomfortable symptoms and/or complications. It has a multifactorial and partially understood pathophysiology. GERD starts in the stomach, where the refluxate material is produced. Following the trajectory of reflux, the failure of the antireflux barrier, primarily the lower oesophageal sphincter and the crural diaphragm, enables the refluxate to reach the oesophageal lumen, triggering oesophageal or extra-oesophageal symptoms. Reflux clearance mechanisms such as primary and secondary peristalsis and the arrival of bicarbonate-rich saliva are critical to prevent mucosal damage. Alterations of the oesophageal mucosal integrity, such as macroscopic oesophagitis or microscopic changes, determine the perception of symptoms. The intensity of the symptoms is affected by peripheral and central neural and psychological mechanisms. In this Review, we describe an updated understanding of the complex and multifactorial pathophysiology of GERD. It is now recognized that different GERD phenotypes have different degrees of reflux, severity of mucosal integrity damage and type, and severity of symptoms. These variations are probably due to the occurrence of a predominant pathophysiological mechanism in each patient. We also describe the main pathophysiological mechanisms of GERD and their implications for personalized diagnosis and management.

External Auditory Canal Granulations of Varying Aetiology Other than Cholesteatoma: A Series of Seven Cases

External Auditory Canal (EAC) granulations can occur due to various causes, each with different presenting features, treatment options, and prognoses. They can arise from trivial situations, such as a neglected Foreign Body (FB), or indicate serious pathology like squamous cell carcinoma. The most common causes of EAC granulations are otitis media, including squamous and mucosal types. However, clinical practice encounters numerous other rare and common causes. The present case series describes seven patients with EAC granulations resulting from different aetiologies apart from Chronic Suppurative Otitis Media (CSOM). The study was conducted over a six-month period at a Government Medical College (GMC) in North Odisha. It aims to assist clinicians in considering these situations when managing patients with EAC granulation. Proper diagnosis and treatment of these patients resulted in successful outcomes. Therefore, the author recommends considering these underlying causes whenever EAC granulations do not respond to appropriate medical treatment with antibiotics. Radiological imaging, fine needle aspiration cytology, and histopathological studies can help exclude many of these causes from the list of differential diagnoses.

Assessment of Eustachian Tube Function for Successful Tympanoplasty in Chronic Otitis Media

Introduction: Eustachian tube function (ETF) has been the focus of attention as a prognostic factor for successful tympanoplasty surgery, due to its supposed primary pathogenic role in otitis media. Poor Eustachian tube (ET) function has been blamed to many diseases of middle ear cleft extending from serous otitis media to the squamosal type of chronic otitis media (COM). The objective of this study was to evaluate the effect of ETF on tympanoplasty outcome in the mucosal type of COM patients. Materials and Methods: An observational study was conducted for the patients admitted to the department of ENT and HNS with COM, mucosal type. The study was done from April 2021 to March 2022. ETF was assessed with the Toynbee test and saccharin time test. Results: The mean saccharin clearance time was found to be 17 min. Tympanoplasty was performed on 55 patients; 91.1% of patients showed successful outcome with good graft uptake who had normal ETF; out of 20 patients with partial dysfunction, 12 patients had successful graft uptake, and eight patients showed graft rejection. Conclusion: The automatic Toynbee test can be a practical, objective, and suitable method to assess the ventilatory function of ET. The saccharin test is an easy, cost-effective, and useful diagnostic tool to assess the mucociliary function of the ET. The ventilatory function of ET which is the single most important contributory factor in the pathogenesis of COM should be evaluated with the objective method before tympanoplasty.

Modeling the effects of prebiotic interventions on luminal and mucosa-associated gut microbiota without and with Clostridium difficile challenge in vitro.

Prebiotics can modulate the gut microbial community composition and function for improved (gut) health and increase resilience against infections. In vitro models of the gut facilitate the study of intervention effects on the gut microbial community relevant to health. The mucosa-associated gut microbiota, which thrives in close contact with the host plays a pivotal role in colonization resistance and health. Therefore, we here introduce the Mi-screen, an experimental approach implementing a 96-well plate equipped with a mucus agar layer for the additional culturing of mucosa-associated microbiota in vitro. In this study, we screened the effects of 2'-Fucosyllactose (2'-FL), fructooligosaccharides (FOS), and inulin within a complex microbiota without and with infection with the C. difficile strains ATCC 43599 (Ribotype 001) or ATCC BAA-1870 (Ribotype 027). We analyzed the microbial community composition and short-chain fatty acid levels after 48 h of incubation. The inclusion of an additional substrate and surface in the form of the mucus agar layer allowed us to culture a microbial richness ranging between 100-160 in Chao index, with Shannon indices of 5-6 across culture conditions, indicative of a microbial diversity of physiological relevance. The mucus agar layer stimulated the growth of characteristic mucosa-associated bacteria such as Roseburia inulinovorans. The prebiotic interventions affected luminal and mucosal microbial communities cultured in vitro and stimulated short-chain fatty acid production. FOS, inulin and 2'-FL promoted the growth of Bifidobacterium adolescentis within the mucosa-associated microbiota cultured in vitro. When spiking the untreated conditions with pathogenic C. difficile, the strains thrived within the luminal and the mucosal sample types, whereas prebiotic treatments exhibited inhibitory effects on C. difficile growth and prevented colonization. In conclusion, the Mi-screen facilitates the screening of luminal and mucosa-associated gut microbial community dynamics in vitro and therefore fills an important gap in the field of in vitro modeling.

Intra-Operative Ossicular Chain Status in Patients with Chronic Otitis Media.

The Objective of the study was to assess the ossicular status in chronic otitis media (COM)-mucosal and squamosal type and statistically evaluate the extent of ossicular destruction intraoperatively in COM patients. The findings of this study could help us to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. The study was carried out in ENT department of tertiary health care hospital, between January 2019 to January 2020. All patients of all age groups and both genders, diagnosed with COM Mucosal and Squamosal Type with complaints of ear discharge and hearing loss with good cochlear reserve and requiring surgery were included in the study, after taking informed written consent in vernacular language. All the patients included in the study were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for ear surgery and the middle ear status and ossicular chain status were assessed using a microscope intraoperatively. Out of 98 patients, 45(45.9%) had mucosal and 53 (54.08%) had squamosal disease. Ossicular chain was eroded in 69 cases (70.5%). 23 out of 45 (51.1%) mucosal cases and 46 out of 53 squamosal cases (86.7%) reported ossicular erosion. Most frequently involved was long process of incus > stapes > malleus. From our study, we concluded that there is a significant relationship between type of disease pathology in middle ear and ossicular erosion being higher in Squamosal type of COM, with malleus being the most resistant and incus being the most susceptible ossicle.

Chronic Otitis Media among Patients Visiting Community-Based Static Outreach Clinics.

Chronic otitis media is a chronic inflammation of the middle ear and mastoid cavity, with recurrent ear discharges or otorrhoea through a tympanic perforation for the past 3 months. It is a common cause of hearing impairment, disability, and poor scholastic performance and can lead to fatal intracranial infections and acute mastoiditis. This study aimed to find out the prevalence of chronic otitis media among patients visiting community-based static outreach clinics. A descriptive cross-sectional study was conducted among patients visiting the community-based static outreach clinics from 1 January 2017 to 31 December 2019. The ethical approval was taken from the Ethical Review Board. The diagnosis of chronic otitis media was done using otoscopy. The records of patients coming to outreach clinics visiting for ear, nose and throat care were reviewed using a pre-designed study proforma. A systematic random sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 385 patients, 37 (9.61%) (6.67-12.55, 95% Confidence Interval) had chronic otitis media. The mean age of patients with chronic otitis media was 27.59±13.24 years, with 28 (75.67%) patients aged between 18-60 years. Among them, 30 (81.08%) had unilateral and 34 (91.89%) had a mucosal type. The prevalence of chronic otitis media was lower than in other studies done in similar settings. community health services; otitis media; patients; prevalence.

Mucocele of the Anorectal Pouch: Mucinous Cystic Neoplasm with Low-Grade Dysplasia Simulating Low- Grade Appendiceal Mucinous Neoplasm (LAMN)

Abstract Introduction/Objective We present the second case of colonic mucocele with dysplasia. To date, only five cases of colonic mucocele have been reported, all in the setting of a pouch or bypass, with only one of them showing dysplasia. The exceptional rarity of the lesion provides unique insight into etiology of mucocele. Methods/Case Report A 44-year-old male with complex surgical history including pull-through procedure for imperforate anus at birth, and later proctectomy with end colostomy due to poor anorectal function, presented with worsening low back pain radiating down to his left leg. An abdominal CT scan revealed a large pelvic cyst, causing compressive neuropathy. Multilocular cystic mass (17.5 cm) was resected, which was partially filled with mucinous material. Mucin was not seen on the cyst surface. On microscopic examination, the cyst was largely denuded however was partially lined by markedly attenuated ano-rectal type mucosa and focally by dysplastic glandular epithelium. Similar to LAMN, pools of acellular mucin dissecting stromal tissues were noted, associated with degenerative changes, calcifications and fibrosis. No invasive carcinoma or high-grade dysplasia was seen. Given the lack of extra- cystic mucin or evidence of overt malignancy, it was reported as mucinous cystic neoplasm with uncertain malignant potential. The patient has been followed for 16 months without evidence of recurrence or peritoneal disease. Results (if a Case Study enter NA) NA Conclusion Extended stasis within a bowel segment appear to contribute to the development of mucoceles. The blind-ended anatomy of the appendix renders it highly susceptible to this phenomenon, explaining the relatively high incidence of LAMN. Conversely, such prolonged stasis rarely occurs elsewhere in colon unless a pouch or bypassed segment is surgically created, particularly placing patients with a complex surgical history at the highest risk. Therefore, close follow-up is indicated in this patient group to screen for mucocele that may progress to develop dysplasia and mucinous neoplasm.

Type 2 Biomarkers for the Indication and Response to Biologics in CRSwNP.

Three biologics targeting type 2 inflammation have been approved for the treatment of severe and uncontrolled chronic rhinosinusitis with nasal polyps (CRSwNP). Nevertheless, around 40-60% of patients do not respond well to these biological treatments. Selecting appropriate patients is crucial to improve treatment outcome of biologics. This review summarizes the literature data on type 2 biomarkers, with a specific focus on the indication to biologics for severe CRSwNP. No consensus has been reached on how to define mucosal type 2 inflammation in CRSwNP. Clinical markers (e.g., 22-item Sino-nasal Outcome Test (SNOT-22) score, Lund-Mackay CT score (LMS), ethmoid/maxillary sinus CT score, and CT-radiomics), nasal secretion biomarkers (e.g., eosinophil cationic protein and interleukin-5), blood and nasal cytology eosinophil counts, and nasal swab eosinophil peroxidase activity have been reported to be associated with type 2 inflammation in CRSwNP. The time duration since the last surgery, SNOT-22 score at 1 week of treatment, and baseline serum osteoprotegerin levels might indicate the response to dupilumab. LMS and asthma control test scores were found to have moderate predictive value for acceptable improvement after 24-week treatment of omalizumab. High blood eosinophil levels at baseline were associated with treatment response to mepolizumab and benralizumab. Although several clinical and biological markers might be associated with type 2 inflammation and response to biologics in patients with CRSwNP, their validity requires further investigation. Identifying clinically applicable biomarkers for biologic treatment holds significant promise for advancing personalized approaches to biologics and optimizing treatment outcomes for patients with CRSwNP.

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The level of micronuclei and other nuclear anomalies in the exfoliative cells of the oral mucosa of diabetes mellitus type I patients and healthy subjects was investigated using the micronucleus test. Correlation analysis was performed based on the results obtained in the exfoliative cells of patients with type I diabetes of the Armenian population with the micronucleus test, their laboratory and anthropometric data, and an extremely small p-value was obtained, which shows very strong evidence of the obtained correlational relationship. Therefore, the research conducted allows us to conclude that type I diabetes has a statistically significant effect on the genetic instability of the organism of patients with diabetes, at the same time having a statistically high cytotoxic and genotoxic effect.

Characterization of type-specific HPV prevalence in a population of persistent cutaneous warts in Flanders, Belgium

Cutaneous warts are benign skin lesions caused by the human papillomavirus (HPV). Even though they are considered benign, they can have a considerable impact on the quality of life and cause serious illness in certain immunocompromised populations. Studies have shown that the efficacy of wart treatment is dependent on the causative HPV type. Therefore, in this article, we aim to determine the HPV genotype-specific prevalence in cutaneous warts of a Flemish population as part of the Omnivirol-Salycilic acid randomized controlled trial. Swab samples of cutaneous warts (n = 269) were collected during enrollment. The DNA extraction was performed on the automated NucliSENS® easyMAG® system (bioMérieux). The samples were analyzed with two separate in-house PCR assays capable of detecting the most prevalent cutaneous HPV types (i.e. wart-associated HPV qPCR) as well as the most relevant mucosal types (i.e. RIATOL qPCR assay). In total, the type-specific prevalence of 30 distinct HPV genotypes was determined. The beta-globin gene was used as a cellularity control and for viral load quantification. Data concerning wart persistence, previous treatment, wart type, and other relevant wart and patient characteristics was collected through a baseline questionnaire. The study population consisted mostly of persistent warts considering that 98% (n = 263) of the sampled skin lesions were older than six months and 92% (n = 247) had undergone previous treatment. The most prominent wart type was the mosaic verruca plantaris (42%, n = 113). The most prevalent HPV types were cutaneous HPV types 27 (73%, n = 195), 57 (63%, n = 169), and 2 (42%, n = 113). Only 2% (n = 6) of the lesions was HPV negative. The highest median viral loads were observed with HPV27 and 57 (i.e. 6.29E+04 and 7.47E+01 viral copies per cell respectively). The multivariate analysis found significant associations between wart persistence and certain wart types, the number of warts, and HPV genotypes. Based on these findings, persistent warts are more likely to: (1) be verruca vulgaris, verruca plantaris simple or mosaic, (2) to manifest as multiple warts, (3) and to be negative for HPV type 2 or 4. These characteristics can be useful in the clinical setting for future risk stratification when considering treatment triage and management.Trial registration: NCT05862441, 17/05/2023 (retrospectively registered).

Computed Tomographic Study of Variants of Deviated Nasal Septum in Adult Population: A Descriptive, Cross-sectional, Hospital-based Study

Background: Deviated nasal septum (DNS) is an influential variant of the sinonasal region due to its possible association with varied sinonasal pathologies, mid-facial (skeletal or occlusal) disharmonies and orofacial pain disorders. The aim of the study is to document the prevalence of DNS and to observe and assess the radiographic attributes of its types in adults. Materials and Methods: It is a descriptive cross-sectional study in which, after getting ethical approval, computed tomography paranasal sinus volumes of 100 adult subjects are collected from the medical college on the basis of convenience sampling. Paediatric subjects and patients with a previous history of mid-facial trauma, malignancy or surgery are excluded from the study. DICOM data thus collected are retrospectively analysed by RadiAnt DICOM viewer to determine the prevalence of DNS to study its association across gender and with increased (>1 mm) mucosal thickening of the maxillary sinus. DNS is recorded by Mladina’s classification and by septal deviation angle, and association is studied by the Chi-square test and Mann–Whitney U test. Results: The overall prevalence of DNS is 82%. Association of deviated septum with gender and mucosal thickening of the sinus lining is not statistically significant. Overall type V (spur) deviation is most common; however, in subjects with thickened mucosal lining type III (“C” or reverse “C”), deviation is found to be most prevalent. All the cases of type VI deviation have a tilted nasal floor, a finding of dental surgeon’s interest. “Bridging Spur,” an uncommon form of spur deformity, is also recorded in one case. Conclusions: Deviated septum is far more common than straight septum in the adult population. Types III, II and IV are more frequent in subjects with increased mucosal thickening. Association of type VI with tilted floor and rare variants like “Bridging spur” is also reported.

A Narrative Review on Oral Mucosa Biomechanics and Clinical Implications of Periodontal and Implant-Related Regenerative Procedures.

Healing outcomes of periodontal and implant-related regenerative procedures are closely related to wound stability, which is partially determined by biomechanical properties and behaviors of oral mu- cosal tissues. Studies on soft tissue behavior under biomechanical forces in oral regeneration models are scarce. Thus, this review aims to (1) contrast the microstructural differences between the attached gingiva (AM) and lining (LM) mucosa; (2) evaluate biomechanical behaviors of the two mucosal types; and (3) relate residual flap tension to the prevalence of wound opening after regenerative procedures. Compositional and structural differences between the AM and LM explain their biomechanical property differences. Wound destabilizers, including tissue recoil stemming from its viscoelastic property, muscle pull, and inflammatory edema (created after the flap-releasing procedure for primary wound closure) in- terfere with wound stability. Residual flap tension < 0.05 N is a prerequisite for sustained wound closure. Tissues under stress can exert negative cellular changes, resulting in necrosis and wound dehiscence. Biomechanical properties and the variations between AM and LM dictate the degree of wound stability. Efforts should be made to reduce the negative impact of the potential destabilizers to optimize wound stability.

Comparative Study of the Outcome of Tympanoplasty Alone with Tympanoplasty Combined with Cortical Mastoidectomy in Patients with Quiescent Mucosal Chronic Otitis Media

ABSTRACT Aims: 1. To compare the outcome of tympanoplasty alone with tympanoplasty combined with cortical mastoidectomy in patients with quiescent Chronic otitis media (COM). 2. To assess gain in hearing in dB. Materials and Methods: Patients diagnosed with mucosal type of chronic otitis media in the quiescent stage were selected. Two groups were formed. Patients were selected randomly and alternately they were included in groups A and B. The patients underwent otomicroscopy. Pure tone audiometry would depict pure conductive hearing of hearing loss. Group A (50% patients) were subjected to tympanoplasty alone and group B (other 50% patients) were subjected to tympanoplasty combined with cortical mastoidectomy. Prior to surgery, all patients underwent routine blood and urine examination, pure tone audiometry, and B/L mastoid X-ray Schuller’s view. Results: In our study, hearing gain in decibels in the tympanoplasty group was 17.1% and in tympanoplasty combined with cortical mastoidectomy was 21.1%. Graft uptake was 94% in the tympanoplasty group and 96% in tympanoplasty combined with cortical mastoidectomy. Recurrence of discharge was seen in three cases of tympanoplasty. Though tympanoplasty combined with cortical mastoidectomy is better in hearing improvement, graft uptake but the difference in two groups is statistically insignificant. Conclusion: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis. Media: Clinical significance: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis media.

Association of Pre-operative Eustachian Tube Function with the Graft Uptake After Tympanoplasty.

To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the correlation of eustachian tube function with the results-i.e., success or failure of tympanoplasty in these patients in terms of graft uptake. This was a prospective observational study carried out over one and half years in Department of E.N.T. & Head and Neck Surgery, a tertiary care hospital. The study group comprised of eighty-seven patients who were diagnosed with chronic otitis media mucosal type- inactive stage and were planned for tympanoplasty or tympanoplasty with cortical mastoidectomy. Written informed consent was taken from all patients. The eustachian tube function was assessed preoperatively by impedance audiometry (Toynbee's test). The surgical outcome was tested by looking at the status of the tympanic membrane postoperatively. The surgical outcome in terms of whether a defect was present in the tympanic membrane was compared with the preoperative eustachian tube function. 98.6% of patients with successful surgical outcome had normal eustachian tube function preoperatively while the neo-tympanic membrane was intact in 63.63% and 33.33% of patients with pre-operative partially impaired and grossly impaired eustachian tube function respectively. From our study, we concluded there was a strong association between functioning eustachian tube and graft uptake in tympanoplasty. So eustachian tube plays important role in successful outcome of surgery.

Bacteriological Profile and Drug Susceptibility in Mucosal type Chronic Suppurative Otitis Media.

In Chronic Suppurative Otitis Media, mucosal type, most common organisms are Pseudomonas aeruginosa and Proteus species (P. mirabilis and P. vulgaris). It is important to prescribe culture-directed antibiotics to prevent resistance. This study was conducted to determine the bacteriological profile and drug susceptibility in patient with chronic suppurative otitis media. This is a hospital-based descriptive study done at Gandaki Medical College, Pokhara, Nepal from July 2019 to June 2020. Under aseptic condition, the swab specimens were obtained from patients with history of ear discharge of >12 weeks duration and findings central perforation of the tympanic membrane. The sample was labeled and immediately transferred to the microbiology lab for culture/sensitivity test according to the guidelines of the Clinical and Laboratory Standards Institute. Out of total 127 patients, 48 (37.8%) were male and 79 (62.2%) were female. One hundred and seven samples (84.3%) had positive culture while 20 samples (15.7%) had no growth. Staphylococcus aureus (43%), was the most common isolate followed by Pseudomonas aeruginosa (23.4%), Proteus mirabilis (9.3%), and Escherichia coli (8.4%). All the organisms isolated were 100% sensitive to imipenem followed by 96.2% sensitive to gentamicin and 95.3% to amikacin. Staphylococcus aureus (43%) was the most predominant isolate followed by Pseudomonas aeruginosa (23.4%), Proteus mirabilis (9.3%), and Escherichia coli (8.4%). Imipenem was the most sensitive antibiotic (100%) followed by gentamicin (96.2%), amikacin (95.3%), and ofloxacin (88.78%).

Hearing Assessment After Total Annular Excision Tympanoplasty- Our Institutional Experience.

The objectives of this study were to record graft uptake, hearing status and any complication(s) after total annular excision (TAE) tympanoplasty and to compare them with previously operated underlay tympanoplasty patients. Prospective study. Patients with chronic otitis media mucosal type aged between 15-45 years attending our outpatient department were assessed and eligible patients who gave consent for the study were included. Patients of chronic otitis media mucosal type who underwent TAE tympanoplasty had 80% graft uptake. Post TAE tympanoplasty patients had good hearing assessed by tuning fork test and pure tone audiometry. Maximum improvement in hearing was seen at 500Hz frequency by pure tone audiometry in TAE tympanoplasty group. Histopathological examination of remnant tympanic membrane showed mucosalization. TAE tympanoplasty can effectively prevent development of granular myringitis. The online version contains supplementary material available at 10.1007/s12070-023-04083-8.