Preoperative Air-bone Gap Research Articles

Comparison of biodegradable synthetic polyurethane foam versus Gelfoam packing in cartilage graft myringoplasty procedures

ObjectiveTo compare cartilage graft rates and graft morphologies when biodegradable Synthetic Polyurethane Foam (BSPF) and Gelfoam are used to pack the EAC after cartilage graft myringoplasty. MethodsEighty-two patients with chronic perforations underwent endoscopic myringoplasty and were randomized to receive Gelfoam or BSPF packing of the middle ear and EAC.The groups were compared with respect to the pre- and postoperative air-bone gap (ABG), graft integrity, graft epithelialization, graft lateralization, and exudate. ResultsGraft success rate was 87.8% in postoperative 3rd month and 87.8% in postoperative 12th month in the Gelfoam group, whereas graft success rate was 97.6% in postoperative 3rd month and 95.1% in postoperative 12th month in the BSPF group, with no statistical significance between two groups in the 3rd (P = 0.089) and 12th (P = 0.236) month after surgery. Comparing the two groups, there was no difference in preoperative or postoperative mean ABG and ABG closure. Graft lateralization or medialization was evident in 6 patients in the Gelfoam group and one in the BSPF group. Re-peroration occured in one patient in the BSPF group. ConclusionsAlthough cartilage graft myringoplasty between Gelfoam packing and BSPF packing of EAC achieve similar graft success rate and ABG closure, BSPF packing afford better graft support and less exudation than did Gelfoam, well prevent graft lateralization and promote earlier graft epithelialization.

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.

Clinical study of butterfly cartilage myringoplasty for anterior quadrant tympanic perforation under endoscope

Objective: To evaluate the results of butterfly cartilage myringoplasty for anterior quadrant tympanic perforation under endoscope. Methods: Thirty-eight patients with anterior quadrant tympanic perforations who were subjected to endoscopic butterfly cartilage myringoplasty from April 2016 to October 2018 were included in this study, including 16 males and 22 females, with an average age of (34.5±14.2) years. The patients were reviewed retrospectively, and the pre-and post-operative pure tone audiometry (PTA) thresholds, pre-and post-operative air-bone gaps (ABG), post-operative graft success rates and complications were evaluated. SPSS 23.0 was used to analyze data. Results: Mean post-operative follow-up duration was (9.4±3.1) months (range 6-18 months). The graft survival rate was 94.7% (36/38) . The preoperative and postoperative mean PTA was (30.9±8.9) dB HL and (21.4±7.7) dB HL respectively. Preoperative and postoperative mean ABG was (18.4±6.3) dB and (10.8±6.0) dB respectively. There was significant difference between pre-and postoperative PTA and ABG (t=5.353 and 4.162, P<0.05 for both). A postoperative ABG reduction of (8.3±1.5) dB was reached. Two (4.7%) patients had postoperative myringitis, two (4.7%) had recurrent perforation, and one (2.4%) had lateral healing of transplanted tympanic membrane in the postoperative follow-ups. No intratympanic cholesteatoma was observed. Conclusions: Endoscopic butterfly inlay myringoplasty is a reliable, minimally invasive alternative method to repair anterior tympanic membrane perforations, with high closure rate and low risk of complications.

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.

Hearing gain after tympanoplasty: a prospective study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The aim of the present study was to determine hearing improvement in different types of tympanoplasties by comparing mean preoperative air bone (AB) gap with mean postoperative AB gap. The study focused on reconstruction of tympanic membrane and ossicular apparatus by tympanoplasty alone or tympanoplasty with mastoid surgeries (canal wall up or canal wall down).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 60 patients of either sex having chronic otitis media with conductive hearing loss of &amp;gt;20 dB were included in the study. Each patient had to undergo preoperative and postoperative pure tone audiometry to calculate average AB gap. Patients underwent tympanoplasty, with or without mastoid exploration depending on the disease status. Pure tone audiometry (PTA) was done at 3 months and 6 months and compared with pre-operative PTA. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Preoperatively PTA showed 29 (48.33%) patients had mild degree of hearing loss, followed by moderate degree of hearing loss in 18 (30.0%) patients. 10 (16.67%) patients had minimal hearing loss and moderately severe hearing loss was seen in 3 (5%) patients. Tympanoplasty alone was done in 52 patients (86.67%). Tympanoplasty with canal wall up mastoidectomy was done in 6 (10%) and tympanoplasty with canal wall down mastoidectomy was done in 2 (3.33%) patients. Type I tympanoplasty was performed in 37 (61.6%) patients, type-III tympanoplasty was the type of surgery in 15 (25.0%) patients. Type II and type IV tympanoplasties were performed in 4 (6.7%) patients each separately.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Hearing gain is better in type I tympanoplasty than in tympanoplasty type II, type III and type IV with or without mastoid surgeries.&lt;/p&gt;&lt;strong&gt;&lt;/strong&gt;

Microdrill stapedotomy for otosclerosis with small and large preoperative air-bone gap: a retrospective comparison of results

Background: In otosclerosis mixed hearing loss is the most frequent symptom and arises when the focus involves the stapes footplate. Surgeons usually prefer to wait a minimum air-bone gap of 25 – 35 dB before surgery.Objectives: To evaluate the outcome of microdrill stapedotomy for otosclerosis in patients with a preoperative air-bone gap (ABG) <25 dB versus patients with a preoperative gap ≥ 25 dB.Material and methods: For this retrospective study, the outcomes and complications after microdrill stapedotomy were compared between adult patients with a preoperative small ABG (n = 127, ABG <25 dB) and those with a large ABG (n = 254, ABG ≥25 dB).Results: The postoperative ABG was significantly smaller than the preoperative ABG (p < .05) in both groups; there were no differences in complications rates (severe sensorineural hearing loss, footplate fracture or early postoperative vertigo) between the two groups.Conclusions: Our findings show that microdrill stapedotomy is safe and can be performed even in patients with a preoperative small ABG without increasing the risk of sensorineural hearing loss due to inner ear damage.

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.

A comparative study of post-operative outcomes in type 1 tympanoplasty using tragal chondroperichondrial shield graft and temporalis fascia graft

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Type 1 tympanoplasty is the reconstruction of perforated tympanic membrane with an intact and mobile ossicular chain. Among various autologous graft materials, temporalis fascia and tragal chondroperichondrium are commonly used, having their own merits and demerits. In our study, we have compared the results and postoperative outcomes of tympanoplasty using temporalis fascia and tragal chondroperichondrium.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This prospective comparative study included 60 cases of chronic suppurative otitis media - tubotympanic disease (CSOM-TTD) in a tertiary care centre. They were randomised into two groups of 30 patients each and were subjected to tympanoplasty using either tragal cartilage-perichondrium (group 1) or temporalis fascia graft (group 2) from November 2017 to May 2019. Objective hearing improvement at 1st, 3rd and 6th month postoperative follow-up and graft uptake rate at 3rd month were compared. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Incidence of cases was more in the age group between 31-45 years age group (53.3%). Graft uptake rate was 96.6% for temporalis fascia group and 83.33% for tragal group (p value - 0.194). Preoperative air-bone (AB) gap in group 1 was found to be 25±4.09 dB which improved to 11.73±2.21 dB at 6 months and in group 2, it was 25.7±3.94 dB which improved to 14.06±3.68 dB at 6 months. Mean improvement in hearing for tragal group (13.27 dB) was better than temporalis fascia group (11.64 dB) (p value &amp;lt;0.001).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both temporalis fascia and tragal chondroperichondrium are suitable graft materials for tympanoplasty, although graft uptake was clinically better with the use of temporalis fascia.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

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.

Endoscopic type 3 tympanoplasty: Functional outcomes in chronic otitis media

BackgroundType 3 tympanoplasty is the surgery of choice for middle ear reconstruction in cases where an integral stapes suprastructure and mobile footplate are present. ObjectiveThe objective of this study was to obtain functional results after endoscopic type 3 tympanoplasty in chronic otitis media. Materials and methodsProspective study including 24 patients who underwent endoscopic type 3 tympanoplasty, using PORP for ossicular chain reconstruction (OCR) and cartilage graft for tympanic membrane reconstruction. Audiograms were made preoperatively, and 6 months after surgery. ResultsDry, closed, self-cleaning ears were obtained in 91.7% of the cases. Mean preoperative air-bone gap (ABG) was 30.4dB, mean postoperative ABG was 16.7dB, dB gain of 13.6dB. ABG closure rate to 20dB or less of 79.2%, and to 10dB or less of 29.2%. Conclusion and significanceEndoscopic tympanoplasty and OCR is a valid option for surgeons who are comfortable with the use of endoscopes for middle ear surgery as it allows improved visualization of the prosthesis and graft placement during middle ear reconstruction.

Modified meatotympanoplasty for external auditory canal stenosis and lateralized tympanic membrane: a preliminary study

Background: The surgical treatment of external auditory canal stenosis (EACS) and lateralized tympanic membrane (LTM) is challenging because there is a high risk of postoperative complications.Objectives: The aim of this study was to evaluate the postoperative hearing levels and other outcomes of 10 cases with EACS and LTM.Materials and methods: This was a retrospective preliminary study of patients with EACS and LTM who underwent meatotympanoplasty from 2008 to 2018. Their mean age at surgery was 31.6 years. The surgeries were performed taking into consideration the following: (1) creating a large EAC and functioning tympanic membrane (TM) and (2) avoiding complete mastoidectomy to prevent postoperative cavity problems.Results: The mean follow-up period was 3 years 10 months. The average preoperative and postoperative air-bone gaps (ABGs) were 40.4 dB and 23.0 dB, respectively, and there was a significant difference. A postoperative ABG less than 30 dB was achieved in 80% (8/10) of patients. Four cases had postoperative complications (re-stenosis of the EAC and/or re-lateralization of the TM).Conclusions and significance: The postoperative results presented were comparable to those of previous surgical techniques; however, further development is needed to prevent postoperative complications and earn better hearing results.

Surgical Outcomes of Chronic Suppurative Otitis Media

Objectives: The purpose of this study is to observe the surgical outcomes of chronic suppurative otitis media. 1. To assess the result of surgical procedure to obtain dry and safe ears. 2. To assess the hearing levels after surgery. 3. To observe the complications that occur during the operation and in the immediate postoperative period&#x0D; Methods: A total 60 patients with CSOM (active squamous variety) who underwent tympanomastoid surgery studied in a period of 1 year from July 2013 to June 2014 at CMH Dhaka.&#x0D; Results: The maximum patients were from15-24 years (35%) age group, male to female ratio was 1.2:1. Highest number of patients (39%) was from middle class family. All the 60 patients presented with discharge from ear and hearing impairment. Maximum (40%) were with attic and postero-superior marginal perforation along with granulation tissue. In 1stpost op month,53 (88.33%) manifested dry ear and in 3rd month after operation 52 (90%) patients manifested dry ear. 7 (11.66%) patients showed discharge from the ear after 1st month which decreased to the 0% after 3rd month. Graft was taken successfully in 56 (93.33%) patients after the first month of operation which reduced to 51 (85%) after third month of operation. Hearing status of the patients before operation proclaimed that 48% patients suffered from moderate hearing loss, 22% and 17% patients suffered from mild and moderately severe loss respectively. 13% patients suffered from severe hearing loss After surgery 86% patients’ condition was improved, 4% patients’ condition deteriorated and 10% patients’ condition remain unchanged . The mean preoperative air-bone gap was 32.10 dB and mean postoperative air-bone gap was 19.10 dB .&#x0D; Bangladesh J Otorhinolaryngol; October 2017; 23(2): 187-194

Bilateral same-day endoscopic tympanoplasty.

Although bilateral same-day tympanoplasty is a faster and more comfortable procedure for patients, it is rarely performed due to its theoretical risks. The present study aims to evaluate the results of patients who underwent bilateral same-day endoscopic tympanoplasty. In this study, 26 patients and 52 ears were evaluated. Postoperative anatomic success rate, pre- and postoperative hearing test results, hearing gains and postoperative complications were recorded. Postoperative anatomic success rate was 92.3% (48/52). Audiological tests revealed the preoperative air-bone gap (ABG) as 19.1±8.8 (7-35) dB and postoperative ABG as 9.8±5.7 (5-25) dB. Postoperative ABG decreased significantly (p: <0.001) and 9.2±4.6 (2-23) dB hearing gain was obtained. We did not observe any significant complications. Bilateral same-day endoscopic tympanoplasty is a feasible surgical procedure with good anatomic and functional outcomes, low complication rate and good postoperative patient comfort.

Hearing Results Following Type 1 Tympanoplasty in Elderly Patients.

The outcomes of type 1 tympanoplasty in elderly patients remain controversial. Therefore, more studies are needed to clarify the prognosis of elderly patients after tympanoplasty. The purpose of this study was to evaluate the clinical outcomes of type 1 tympanoplasty in elderly patients. We retrospectively analyzed data from 116 patients who underwent type 1 tympanoplasty due to chronic otitis media. Seventy-one of the 116 patients were elderly individuals aged 65 years or older (study group). Forty-five patients were younger than 65 years (control group). Due to cochlear intolerance by aging in the study group, we used dexamethasone soaked gelfoam packing in the middle ear and intraoperative dexamethasone injection. To compare the outcomes between groups, we determined the mean hearing levels by averaging the hearing thresholds. The differences in the air-bone gaps before and after tympanoplasty were compared between groups. In the study group, 54 patients had an underlying disease (76%). Hypertension was the most common underlying disease. The postoperative air conduction (AC) and bone conduction (BC) improved in both the study group and the control group. In the control group, postoperative air-bone gap (ABG) was significantly higher than preoperative ABG. Although the postoperative ABG improved in the study group, the improvement was insignificant. Although significant improvement of ABG was not achieved, postoperative AC and BC were improved. Intraoperative dexamethasone injection and dexamethasone soaked gelfoam packing in the middle ear was effective to prevent deterioration of BC after operation.

Pediatric tympanoplasty: Our experiences in a tertiary care teaching hospital of Eastern India

Objective: The study objective was to study successful graft uptake and hearing gain by using different graft materials in pediatric tympanoplasty. Materials and Methods: Patients younger than 16 years of age who had undergone tympanoplasty between January 2016 and February 2019 were included in this study. Temporalis fascia or perichondrium was used as the graft material in tympanoplasty. Patient details such as age, sex, side of operated ear, operation technique, audiological profile before and after surgery, and the status of postoperative graft were noted. An intact graft and air–bone gap (ABG) ≤25 dB were considered as successful outcome after postsurgical period. Preoperative audiogram and audiogram after 6 months of surgery were advised for comparison.Results: Thirty-six pediatric patients were included in our study. Temporalis fascia graft was used as the graft material in 22 patients and cartilage graft was used as the graft material in 14 patients. The successful graft uptake was 89% in the temporalis fascia group, whereas it was 96% in the cartilage group. In temporalis fascia group, ABG before surgery was 35.53 dB, ABG after surgery was 17.12 dB, and the postoperative gain was 18.41 dB. In the tragal cartilage group, preoperative ABG was 32.42 dB and postoperative ABG was 15.13 dB, with a postoperative gain of 17.29 dB. The comparison between the temporalis fascia and the tragal cartilage groups was statistically significant for successful graft uptake (P = 0.0119) and hearing outcome (P = 0.0484). Conclusion: Temporalis fascia gives better hearing outcome, whereas tragal cartilage gives better graft uptake in pediatric tympanoplasty.

Endoscopic transcanal stapedotomy: Our experiences at a tertiary care teaching hospital of Eastern India

Introduction: Although operating microscope is used worldwide for stapes surgery, the use of endoscopes would provide much benefit such as good panoramic view of middle ear and easy accessibility of the oval window area, stapes, and facial nerve. Objective: We aimed to analyze our experiences of endoscopic transcanal stapedotomy performed at a tertiary care teaching hospital of Eastern India. Materials and Methods: This prospective study was done at the Department of Otorhinolaryngology between March 2017 and April 2019. The patients were diagnosed as having otosclerosis with fulfilling the selection criteria. All underwent endoscopic transcanal stapedotomy. Results: Out of 52 patients those underwent endoscopic transcanal stapedotomy, there were 28 females and 24 males. The mean age was 32.40 years. The mean operation time was 35.43 min. The mean preoperative air–bone gap (ABG) was 34.84 dB, whereas the mean postoperative ABG was 9.81 dB. Tympanomeatal flap tear was seen in one case. One case showed chorda tympani injury and two patients presented with vertigo after surgery. No other complications were seen after endoscopic stapedotomy. Conclusion: The important advantages of endoscopic stapedotomy are good-quality visualization with identification of vital parts of the middle ear cleft, minimal handling to the chorda tympani nerve with almost no curettage of the scutum. The development of endoscopic ear surgery techniques promises the change the way we approach for stapes surgery. The wide field view of endoscope helps the surgeon to visualize better the middle ear recess, especially oval window niche and stapes.

Analysis of transcanal endoscopic ear surgery for antrum cholesteatoma

Objective:To report surgical techniques, outcomes, clinical experience and application key point of transcanal endoscopic ear surgery for tympanic antrum cholesteatoma. Method:Data from 27patients who underwent transcanal endoscopic ear surgery for tympanic antrum cholesteatoma were retrospectively analyzed. Removal of tympanic antrum cholesteatoma and tympanoplasty were individualized. Patients were followed up at postoperative 1, 3 and 6month. Result:There was no failure of tympanal and canal wall reconstruction. The mean preoperative air conduction threshold was（50.33±7.34） dB HL, compared to（29.59±5.56） dB HL postoperatively P=0.00）. The mean preoperative air-bone gap was（29.13±4.70） dB, compared to（12.25±4.98） dB postoperatively（P=0.00）. There was no complication, recurrence, residual tympanic antrum cholesteatoma or secondary surgery needed. Conclusion:Stand alone transcanal endoscopic ear surgery is a safe and effective for tympanic antrum cholesteatoma.