Subtotal Perforations Research Articles

Raising a mucosal flap vs. tympanomeatal flap to repair subtotal perforations.

Raising a mucosal flap vs. tympanomeatal flap to repair subtotal perforations.

Status and Depth of Mastoid Antrum and the Pattern of Mastoid Pneumatization in Cases of Large, Subtotal Perforations and Posterosuperior Retraction Pockets (PSRP).

The present study aimed to evaluate the pneumatization status of the mastoid air cells in general with the depth and status of mastoid antrum in particular, in patients of chronic otitis media (COM). This is an observational cross-sectional study in sample size of 60 participants with large, subtotal perforation and posterosuperior retraction pocket (PSRP). Mean age with large central and subtotal perforation combined was 35.78 years, compared to 32.13 years in PSRP. Granulations seen in antrum in 71.6% and cholesteatoma observed in 15%. Mean depth of the mastoid antrum was 17.27 mm. A well pneumatized mastoid in 21.6%, diploic 28.3% and sclerotic in 50% was noted in this study. Chronic otitis media affects temporal bone pneumatization, particularly the mastoid antrum. Our findings indicate that the depth of the mastoid antrum is slightly greater in cholesteatoma cases due to bone erosion. As early intervention enhances postoperative quality of life by preserving or restoring auditory function, understanding the mastoid pneumatization and antrum depth is crucial for managing chronic otitis media effectively.

Endoscopic Broad Palisade Cartilage Graft Without Raising a Tympanomeatal Flap in the Repair of Subtotal Perforation.

Objective: This study evaluated the outcome of a broad palisade cartilage graft in the repair of subtotal perforation. Study Design: Prospective case series. Materials and Methods: This was a prospective study of 43 patients with subtotal perforations who underwent an endoscopic broad palisade cartilage graft procedure that did not include raising a tympanomeatal flap. The patients were followed up for 6 months. Results: The 43 patients (43 ears) included in this study had a mean operation time of 38.6 ± 7.4 minutes. Five (11.6%) patients were lost to follow-up; 38 (88.4%) completed the 6 month follow-up. The graft success rate in the latter was 92.1% (35/38). Audiological testing showed no sensorineural threshold shift. The mean preoperative air-bone gap (ABG) was 28.4 ± 5.1 dB, while the mean ABG at 6 months postoperatively was 13.6 ± 3.1 dB; the difference between these values was significant (P < .05; paired samples t test). According to the audiometry assessment, the successful surgery rate (postoperative ABG ≤ 20 dB) was 89.5% (34/38). No graft-related complications (eg, graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. However, granular myringitis with minimal moistness but without infection was noted in 5.3% (2/38) of the patients. Conclusions: In the repair of subtotal perforation, an endoscopic broad palisade cartilage graft, performed without raising a tympanomeatal flap, is simple and feasible, resulting in a high graft success rate and good hearing restoration.

Graft Healing Process Following Cartilage Myringoplasty Without Trimming of the Perforation Margin.

Objective: The objective of this study was to endoscopically evaluate the graft healing process and graft success rate following cartilage myringoplasty, without trimming of the perforation margin or external ear canal (EAC) packing. Material and Methods: Patients with chronic tympanic membrane (TM) perforation underwent endoscope cartilage underlay myringoplasty, without trimming perforation margin or EAC packing. The healing process of the cartilage graft and the graft success rate were evaluated at 6 months postoperatively. Results: Fifty-eight ears were included in this study. At 1 week postoperatively, clinical inosculation and neovascularization of the graft were observed in small- and medium-sized perforations, but not in large or subtotal perforations. At 2 weeks postoperatively, graft clinical inosculation and neovascularization were completed in the small- and medium-sized perforations; however, neovascularization of the graft had only just begun in the large perforations. At 3 weeks postoperatively, completion of the graft clinical inosculation was achieved in 57 of the 58 ears. At 4 weeks postoperatively, complete neovascularization was achieved in all perforations. Of the 58 ears, postoperative infection resulted in residual perforation in 1 ear, and an insufficient graft resulted in residual perforation in a large perforation without infection. Overall, the graft success rate was 96.6% (56/58). There was no correlation between the graft success rate and graft neovascularization score. Conclusions: The graft healing process experienced the dilation of the blood vessels of the remnant TM, graft clinical inosculation, and neovascularization following cartilage myringoplasty without trimming of the perforation margin and EAC packing; however, the graft success rate was not related to the endoscopic graft neovascularization scores.

Correlation Between Pure Tone Audiometry Values and Middle Ear Ossicular Chain Status in Chronic Otitis Media: Study in a Tertiary Health Care Centre.

In this study, we attempt to compare the pure tone audiometry findings with ossicular chain status intraoperatively in patients of chronic otitis media. 102 patients who presented with COM during a period of one year and met the inclusion criteria were included in the study. All patients underwent preoperative pure tone Audiometry and findings were tabulated. All patients were evaluated intraoperatively by the same surgeon and observations were made regarding ossicular chain integrity. Small central perforation was noted in 10%, medium central perforation in 38.57%, large central perforation in 27.14% and subtotal perforation in 24.28%. 71.56% patients had an intact ossicular chain, of which 94.5% was mucosal disease and 5.5% were squamous disease. 29 cases showed eroded/absent ossicles, out of which, 28 had squamous type and 1 case had central perforation. Ossicular status was classified based on Austin Classification. Conductive hearing loss was found to be maximum where all 3 ossicles were eroded/absent, with a mean AB gap of 45.33 and mean air conduction threshold of 60.33. There is a good correlation between the hearing threshold of the patient and the status of ossicular chain. Preoperative knowledge of the degree of hearing loss and status of ossicular chain would allow the surgeon to plan proper ossicular reconstruction and give the patient a better advice regarding prognosis of hearing improvement after surgery.

Additional cartilage reinforcement of the annulus in myringoplasty for subtotal perforation

ObjectiveIn this study, graft success, hearing outcome, and complications were compared following the repair of subtotal perforation using a cartilage reinforcement underlay technique (CRUT) versus the traditional cartilage underlay technique (TCUT). Study designRandomized controlled trial. Materials and methodsSeventy-six patients with subtotal perforations were prospectively randomized to the CRUT (n = 38) or TCUT (n = 38) group. The graft success rate, hearing outcome, and complications were compared at 12 months. ResultsThe mean operation time was 32.9 ± 4.2 (range: 26–47) min in the CRUT group and 51.8 ± 6.3 (range: 48–73) min in the TCUT group (P < 0.001). At 12 months postoperatively, no residual perforation was seen in either group. The graft success rate was 94.7 % (36/38) in the CRUT group and 92.1 % (35/38) in the TCUT group; the difference was not significant (P = 0.643). The postoperative air bone gap (ABG) was significantly improved compared to the preoperative value in both groups, without significant between-group differences in either the preoperative (P = 0.741) or postoperative (P = 0.865) ABG or the mean ABG gain (P = 0.812). Additionally, there were no significant between-group differences in the preoperative (P = 0.887) or postoperative (P = 0.753) mean bone-conduction pure tone average. In the TCUT group, seven (18.4 %) patients developed temporary hypogeusia and two (5.3 %) had external auditory canal scarring. Graft cholesteatoma was not observed in either group. ConclusionIn the treatment of subtotal perforations, lateral reinforcement of the annulus with additional cartilage is simpler than traditional cartilage underlay for achieving graft and hearing success. The technique also does not involve raising the tympanomeatal flap or removing perforation margins.

Outcomes of Palisade Cartilage Tympanoplasty in Chronic Otitis Media: Our Experience at a Tertiary Care Centre.

To evaluate the anatomical and functional success rates of palisade cartilage tympanoplasty in chronic otitis media. Thirty patients with chronic otitis media with subtotal perforation underwent palisade cartilage tympanoplasty and were assessed prospectively. The outcomes evaluated were graft uptake and hearing gain. Overall graft uptake was 90% with failure in 3 cases. The preoperative mean air conduction threshold was 22.087 ± 6.120dB which was improved to 13.387 ± 5.253dB postoperatively at 12weeks which was statistically significant. The mean postoperative ABG closure was 8.700dB with a p value of 0.001 which was statistically significant. Palisade cartilage tympanoplasty demonstrates that subtotal perforations, which are at high risk for graft failure, can be treated efficiently and a durable and resistant reconstruction of the tympanic membrane with reasonable hearing can be achieved.

Surgical and Audiological outcomes of Wet versus Dry Temporalis Fascia Graft in Type 1 Tympanoplasty

Objectives: Evaluate the surgical success and postoperative hearing outcome of type 1 tympanoplasty using temporalis fascia graft in its wet versus its dry fashion.&#x0D; Methods: A prospective randomized comparative study which was conducted in Sulaimanyah otorhinolaryngology &amp; head and neck surgery centre between October 2018 and November 2019 on patients with sign and symptom of tympanic membrane perforation who underwent type1 tympanoplasty in 2 groups in whom wet graft used in one group, and dry graft used in the other group, these patient followed up after 3 month for graft take and postoperative hearing.&#x0D; Results: Of the 29 patients included in the study in 15 of them dry graft used and the graft take was 86.7% and in 14 of the wet graft used and the take rate was78.6%, postoperative mean hearing gain was 14.07 dB in the dry graft group and 12 dB in the wet graft group, all cases in both group had improvement in hearing (P value= 0.001), but neither wet nor dry was better than the other (P value=0.345). Graft take and hearing gain in different site and size of perforations were not significant, graft take rate was 100% in small size and 50% in subtotal perforation, hearing gain was 14.50 dB for subtotal perforation and 9.50 dB in small size perforation, mean time of wet graft group with 75.36 minutes were shorter significantly than the dry graft with 95 minutes with (P value=0.001).&#x0D; Conclusion: The Nature of the temporalis fascia not affect the outcome type 1 tympanoplasty, and temporalis fascia is a good graft material regarding the success rate and hearing gain, however the wet Temporalis fascia graft use may shorten the operation time.

RESULTS OF TYMPANOPLASTY IN TOTAL AND SUBTOTAL TYMPANIC MEMBRANE DEFECTS

Purpose. To carry out a comparative analysis of the results of endoscopic tympanoplasty with auricle cartilage and microscopic tympanoplasty with temporal autofascia in the surgical treatment of total and subtotal perforations of the tympanic membrane. Materials and Methods. 56 patients were devided into 2 groups, the first group had 28 patients after endoscopic type I tympanoplasty with auricle cartilage; the second group had 28 patients after type I tympanoplasty with temporal autofascia. The patients were examined after the surgery in 2, 3, 6, 12 months, anatomical and functional results were assessed, audiometry, and the number of recurrences of tympanic membrane perforations were extimated. Results. The average operation time in the first group (60.2±11.5 min) was significantly less than in the second group (88.3±15.2min; p&lt;0.5). Complete closure of the tympanic membrane perforation and graft engraftment was observed in group 1 in 92.8 %, in group 2 in 89.3 %. The average preoperative air conduction according to audiometry data in group 1 was 42.1±15.4 dB, in group 2 it was 38.2±12.4 dB. The differences of bone-air conduction before the surgery were 18.8±11.6 dB and 19.6±13.3 dB respectively. The bone-air interval before the surgery was 23.3±6.4 dB in group 1, — it was 19.2±7.8 dB in group 2. After the surgery in 1-year follow-up, the average improvement in air conduction in group 1 was 18.1±7.7 dB, in group 2 it was 19.5±7.5 dB. Postoperative bone conduction was 17.8±10.7 dB and 18.8±14.9 dB respectively. The bone-air interval 1 year after the surgery was 10.1±4.6 dB in group 1and 11.5±8.4 dB. There was no statistically significant difference between the two groups.

GRAFT UPTAKE AND HEARING AFTER ENDOSCOPIC PALISADE CARTILAGE MYRINGOPLASTY AT NEPAL MEDICAL COLLEGE TEACHING HOSPITAL

Background: Chronic otitis media mucosal type is commonly encountered in otorhinolaryngology. Myringoplasty is a common surgery performed to repair the tympanic membrane (TM). Management of subtotal perforation of the TM has become better with the use of endoscopes. The use of cartilage as palisade for repair of the TM has become popular. The aim of the study was to assess graft uptake and hearing after endoscopic palisade myringoplasty. Methods: A prospective study was conducted in the otorhinolaryngology department from April, 2022 to January, 2023. The study included 65 patients, aged 21 years and above diagnosed as chronic otitis media mucosal type, inactive with subtotal perforation and conductive hearing loss. History, clinical examination, otoscopy, tuning fork tests, examination under microscope (EUM) were conducted preoperatively. All patients underwent endoscopic palisade cartilage myringoplasty. Pre-operative and post-operative pure tone audiograms of the patients were done to record the air conduction threshold (ACT), bone conduction threshold (BCT) and air bone gap (ABG). SPSS 16 software was used for analysis of results. The statistical tests used for analysis was paired t-test, level of statistical significance was set at the P &lt; 0.05. Results: The mean age of the patients was 28.51±7.20 years with a female preponderance (57.9%). Graft uptake following surgery was 91.9%. There was significant reduction (p&lt;0.001) in the air bone gap postoperatively that suggested improvement in hearing. The mean hearing gain was 13.91±6.79 dB. Conclusions: The use of endoscopic palisade cartilage myringoplasty to correct subtotal perforation has good results in terms of graft uptake and hearing improvement.

A comparative evaluation of graft uptake and audiological results of temporalis fascia graft vs reinforced sliced tragal cartilage in type 1 tympanoplasty

Background: Numerous grafting materials have been applied for repair of tympanic membrane (TM) in chronic otitis media patients. This study aimed to compare the anatomical and audiological results of temporalis fascia alone versus reinforced sliced cartilage in type 1 tympanoplasty. Methods: A prospective study was conducted on 50 patients of age group 15-55 years. Patients were randomly divided into two groups, each group having 25 patients. In group I patients under went type I tympanoplasty with temporalis muscle fascia alone and group II patients with sliced tragal cartilage reinforced to temporalis fascia. Post operatively all patients were followed on 30th, 60th and 90th day. In the last follow up, assessment of graft uptake was done and pure-tone audiometry was performed to evaluate air-bone gap closure. The data so obtained were collected and analysed using appropriate statistical tests. Results: Overall graft uptake rate in group I (TF alone) was 84%, whereas in group II (TF+ reinforced sliced cartilage) was 92% (p=0.5). The mean post op ABG improved to 16.17±6.26 dB and 16.56±5.25 dB respectively in group I and II. There was significant hearing improvement in each group but no statistical significant difference was observed in post-op ABG between the two groups. Conclusions: Reinforced sliced tragal cartilage technique is a good alternative to temporalis fascia alone in terms of graft uptake and prevention of disease recurrence, especially for large and subtotal perforations but additive effect of cartilage slicing in hearing gain still remains little controversial.

A PROSPECTIVE OBSERVATIONAL COMPARATIVE STUDY FOR POST OPERATIVE RESULTS IN ENDOSCOPIC TYMPANOPLASTY V/S MICROSCOPIC TYMPANOPLASTY

Objective: Chronic suppurative otitis media is a widespread disease in developing countries. Hence treating CSOM with surgical treatment by tympanoplasty is the commonest procedure in ENT practice. In this study we aim to study the advantages and disadvantages of microscopic and endoscopic tympanoplasty. This study also aims to compare the merits and demerits of microscopic and endoscopic tympanoplasty. A Prospective Subjects And Methods: observational study for endoscopic tympanoplasty and microscopic tympanoplasty was conducted on 102 patients of age 20-60 years attending OPD and admissions under the Department of otorhinolaryngology and M.Y.H Hospital, Indore. Subjects with dry central perforation due to CSOM were selected for microscopic tympanoplasty. Similar subjects were selected for Endoscopic tympanoplasty except those with tortuous anatomy of external ear canal. Patients with unsafe CSOM, SNHL, and active infection were excluded. In our study majority (44%) of patients Results: belonged to age group of 25-35 years. Most of the patients were having medium central perforation ( MCP) (32%) followed by subtotal perforation (22.5%). Small central perforation (SCO) 19%, Large central perforation (LCP) 18%, Total perforation 10% respectively. According to quadrant involving perforation which is mainly AIQ, followed by Anterior superior quadrant ( ASQ), Posterior inferior quadrant (PIQ) and posterior superior quadrant (PSQ). Mean operative time for Endoscopic tympanoplasty procedure was 56+/-15 mins with SD of 12.05 and for microscopic tympanoplasty procedure was 117.8+/- 20 mins with SD of 7.17 having a p value (0.0003) which was found to be significant. Conclusion: In our study, we have concluded that endoscopic tympanoplasty scores over microscopic tympanoplasty. Endoscopic tympanoplasty has helped patients achieve faster recovery, a shorter hospital stay, and a lower financial burden, which was especially helpful for developing countries like ours. Unlike the microscope, the endoscope is easily transportable and hence is ideal for use in remote places to conduct ear surgery camps.

How Does Preoperative Pure Tone Audiometry Relate to the Findings at Surgery to Explain the Hearing Status in Chronic Otitis Media?

Pure tone audiometry (PTA) guides surgical decision-making in chronic otitis media (COM), and PTA values depend upon the type and extent of COM. Our cross-sectional study included patients with COM with/without cholesteatoma who were scheduled for surgery. Findings on examination of the middle ear under the microscope and at surgery which could explain the hearing loss were corroborated with preoperative PTA through appropriate statistical methods. The study included 114 patients (mean age: 31.07 years; range: 7-57). Following preoperative PTA, 50% of patients had moderate hearing loss and ~73% had air-bone gap (ABG) <35 dB. Conductive hearing loss affected 109 patients (97.61%); five had mixed hearing loss. At surgery, 27 patients (23.68%) had ossicular discontinuity, with the incus being the most affected. Twenty-one patients in this group had ABG ≥35 dB. Perforations involving the anterior and posterior halves of the pars tensa, and subtotal perforations, demonstrated the maximum mean hearing loss [45.39±8.29 dB HL (p=0.075), 51.08±12.51 dB HL (p=0.26), respectively]. The mean pure tone average in the intact ossicles group was 43.62±8.07 dB HL and that in the absent/eroded ossicles group was 58.15±11.05 dB HL (p<0.0001); the mean ABG was 27.89±4.77 dB and 38.88±6.47 dB, respectively (p<0.0001). Hearing loss was significantly associated with the size but not the site of the central perforation. With ossicular discontinuity, hearing loss and ABG deteriorated significantly. The findings re-establish the relationship between preoperative PTA and the middle ear status which should help surgeons plan surgery and counsel patients regarding hearing outcomes.

Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation.

Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

Outcomes of Endoscopic Tympanoplasty for Large Perforations: A Multicenter Retrospective Study in South Korea.

Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations. This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data. In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P<0.001). However, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that the postoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, -11.351; 95% confidence interval, -21.491 to -1.212; P=0.028). This study involved the largest population to date of large TM perforations treated by ET. The study findings suggest that ET is feasible and effective in treating large TM perforations.

Double-layer fascial grafts in Type I tympanoplasty for subtotal perforation: A case–control study

Objective: The objective of this study was to assess the double-layer temporalis fascia grafting for myringoplasty for subtotal tympanic membrane (TM) perforation regarding graft uptake and hearing gain. Patients and Methods: The study included 60 patients with subtotal TM perforation attributed to tubotympanic suppurative otitis media. Myringoplasty was done through a postauricular approach using the underlay technique by two layers of the temporalis fascia grafts in the study group and one layer of the temporalis fascia graft in the control group. The procedure was considered successful if there was no residual TM perforation within the follow-up period. Results: Within included 60 patients, 30 patients in the study included 60 patients, 30 patients in the study group (11 males and 19 females) and 30 patients in the control group (9 males and 21 females). The success rate of TM healing was 100% in the case group and 87.7% in the control group with significant difference (P = 0.038). The hearing gains (>10 dB) were reported in 96.7% in the case group while it was 70% in the control group which is significantly better (P = 0.00558). Conclusion: The double-layer temporalis fascia graft is effective for both postoperative graft taking and hearing improvement for subtotal (Grade 4) TM perforation.

SURGICAL OUTCOME OF MYRINGOPLASTY WITH AND WITHOUT CORTICAL MASTOIDECTOMY IN CHRONIC OTITIS MEDIA MUCOSAL INACTIVE TYPE

Background: Chronic otitis media is usually complicated due to perforation of tympanic membrane and ultimately leading to hearing loss. The objective of this study was to compare the results of myringoplasty alone with myringoplasty with cortical mastoidectomy in COM (Chronic Otitis Media) mucosal inactive type in terms of graft uptake. Methods: This was a descriptive, prospective, qualitative type of study. A total of thirty patients of COM mucosal inactive type were included in the study of which 15 patients were selected alternatively for myringoplasty alone while another 15 patients were selected for myringoplasty with cortical mastoidectomy. Pure tone audiometry was done within 1 week prior to surgery. Graft uptake was assessed after 6 weeks and results were compared within and between the groups using Chi-square test. Results: Graft uptake rate of myringoplasty alone and myringoplasty with cortical mastoidectomy done using temporalis fascia graft and underlay technique was same 86.66% (n=26) and failure rate was 13.33% (n=4).The graft take was higher 88.9%(n=8) in small perforation worsened in medium (85 %) and then in subtotal perforation (79%). Graft uptake rate was highest in central perforation (86.9%) followed by posterior perforation (84.6%) and least in anterior perforation (77.7%). Mean age of presentation was 27.7 years, ranging from 15 to 60 years. Most common approach was permeatal in myringoplasty and postaural in case of myringoplasty with cortical mastoidectomy. Conclusions: The graft uptake rate myringoplasty alone are comparable to those of myringoplasty with cortical mastoidectomy. The choice of surgery is based on surgeon’s preference.

A Prospective Randomised Comparative Study Between Cartilage and Fascia Tympanoplasty in a Tertiary Care Hospital to Look for Better Alternative in High Risk Cases.

CSOM patients are most commonly managed surgically by type I tympanoplasty using either cartilage shield technique or underlay grafting technique. In our study, we have compared the graft uptake and hearing results of type I tympanoplasty using temporalis fascia and cartilage shield, and also reviewed the literature regarding the results of these two methods. 160 patients aged between 15 and 60 years were randomized into two groups of 80 patients each, with odd numbers subjected to conchal or tragal cartilage shield grafting in group I, while in group II with even numbers, the patients underwent temporalis fascia grafting by underlay technique. Three months post-surgery, the graft uptake was seen in 76 patients (95%) in the cartilage shield group as compared to 58 patients (72.5%) in the temporalis fascia group, which was statistically significant between the two groups [Fisher's exact value = 0.000]. The uptake rate was much higher in cartilage shield graft as compared to fascia graft even in complicated cases like revision tympanoplasty (TP), discharging ear, subtotal perforation and retracted/adhered TP. Also, the hearing improvement in fascia and cartilage shield group was not statistically significant comparing pre- and post-operative patients, indicating that there was not much difference in audiological outcomes between the two groups. We advocate the use of cartilage shield graft as a substitute for fascia graft in all feasible cases as well as in complicated situations to improve the success rate of type I tympanoplasty, without compromising on the hearing improvement, as seen in our study. The online version contains supplementary material available at 10.1007/s12070-022-03175-1.

A PROSPECTIVE OBSERVATIONAL STUDY TO ANALYZE RESULTS OF ANTERIOR TUCKING TECHNIQUE OF TYPE-1 TYMPANOPLASTY IN PATIENT OF CHRONIC OTITIS MEDIA MUCOSAL TYPE

Introduction: Chronic otitis media(COM) is a major public health problem in children and adults. Tympanic membrane (TM) perforations lead to recurrent ear infections and hearing loss. Tympanoplasty has been the surgery of choice for the pars tensa perforation of tympanic membrane. Anterior, large and subtotal perforations have a high chance of residual perforation after surgery due to lack of anterior support. To overcome this problem various modications are done in two basic method (overlay and underlay) of graft placement. Aim of our study was to evaluate the results of anterior tucking technique of type-1 tympanoplasty. Methodology: A prospective observational study was done. Total 40 cases of COM inactive mucosal disease with anterior quadrant perforaion enrolled in study. Detailed history, examination and preoperative and postoperative pure tone audiometric(PTA) ndings were noted down preformed proforma. Results: Out of 40 patients graft uptake rate was 90.00% (36 cases). 36 patients had showed the improvement in PTA with average air bone gap gain of 12.02 dB. Conclusions: Anterior quadrant perforation of tympanic membrane requires support to prevent graft medialization and residual perforation. Anterior tucking technique in Type-1 Tympanoplasty increase graft uptake in large, anterior or subtotal perforation with good post-operative hearing outcome.

Can Wideband Absorbance Be Used in the Detection of Ossicular Chain Defects?

Introduction:We aimed to compare the effectiveness of wideband absorbance in detecting ossicular chain discontinuity with intraoperative findings.Materials and Methods:In this study, 58 ears from 38 patients with chronic otitis media (COM) were included. Twenty-six ears with perforation and intact ossicular chain were determined as Group 1, 12 ears with perforation and ossicular chain defects were determined as Group 2, and 20 ears with normal hearing and intact tympanic membrane were determined as Group 3. The comparison of the groups was made considering the static (non-pressure) absorbance analysis performed using wideband tympanometry.Results:When perforation sites were evaluated in Group 1 and Group 2; there were 12 anterior perforations, 7 posterior perforations, and 19 subtotal perforations. Air conduction thresholds in Group 2 were significantly (P<0.05) higher than in Group 1, as expected in pure tone audiometry. When wideband absorbance (WBA) measurements were evaluated in all 3 groups, no significant difference (P>0.05) was found between the frequencies 226 to 1000 Hz. WBA measurements at 8 frequencies between 1888-2311 Hz in Group 1 were significantly lower than Group 3 (P<0.05). WBA measurements at 4 frequencies between 3462-3886 Hz frequencies in Group 2 were significantly lower than Group 1 (P<0.05).Conclusions:Our findings concluded that a significant decrease in absorbance values in the narrow frequency range may be valuable in predicting ossicular chain defects.