Successful Graft Uptake Research Articles

Our Experience in Endoscopic Button Tympanoplasty Providing High Success Rate in Varying Sizes of Perforation : A Case Series.

Cartilage tympanoplasty is a fast growing technique used to restore hearing in chronic suppurative otitis media. The technique has misnomers such as limited applicability in only small size perforations, interference with sound conducting mechanism and durability. Our experience in out tertiary care Institution with over 100 retrospective study cases prove that there is a scope of proving it to be well established technique. That could be used in par with other tympanoplasty techniques. Our retrospective case series of 100 operated between 2021 and 2024 were taken, having unilateral perforation convenience data collection purpose. The overall success rates of cartilage / button tympanoplasty of varying perforation sizes, having a wide range of pure tone audiometry statuses having successful results were discussed, which is indicated as a percentage format. In our retrospective case series, out of our 100 cases we had 90 successful graft uptake cases. The 10% cases were later followed up in our study. It was analysed and concluded that the technique was not the inhibiting factor but the post operative care had prevented the patients from having the desired results. Our results are in accordance with previous case studies for support. Pure tone audiometry were taken pre operatively and post operatively that support cartilage / button tympanoplasty. Cartilage tympanoplasty is a commonly misunderstood technique which if corrected has a wide scope to be used a s a common treatment modality. Data collected and inference were in concordance with previous studies conducted. Tragal cartilage due to its durability, low inflammatory reaction to tympanic membrane, lesser chances of retraction and long term assurance of withstanding environmental conditions has proven to be technique which can be used in regular basis. Cartilage / button tympanoplasty is a technique that has a shorter learning curve for surgeons. With a high demand of cases in chronic suppurative otitis media-Tubotympanic type, button tympanoplasty technique is an assest.

Role of Tympanometric Ear Canal Volumes in Determining Outcome of Myringoplasty in Chronic Suppurative Otitis Media Patients.

Middle ear aeration is a predictive indicator of myringoplasty's successful outcome and tympanometric ear canal volume is a novel investigation that can estimate the volume of middle ear cleft and mastoid air cells. Our aim of this study is to determine the role of tympanometric ear canal volume on myringoplasty outcome in Chronic Suppurative Otitis Media Patients. Prospective analysis involving 50 patients of CSOM was performed on patients undergoing myringoplasty from April 2022 to December 2023. Smokers, Patients with squamosal COM, Bilateral COM, Otitis Externa, and Revision surgery were excluded from the study. The successful outcome of surgery was defined as no tympanic membrane perforation on postoperative follow-up. Analysis was carried out using SPSS. V. 25 and P-value less than 0.05 was considered significant. A total of 50 patients were included in the study with a mean age of 24.4 ± 8.965 and male predominance. Overall graft uptake was 64%. Graft uptake had no significant statistical correlation with age, gender, type, location, or size of perforation. However, there is a significant effect of tympanometric ear canal volume of pathological ear and interaural tympanometric ear canal volume difference on graft uptake with p-values of 0.023 and 0.033 respectively. Tympanometric ear canal volume can predict middle ear aeration and the higher the interaural tympanometric canal difference more are the chances of successful graft uptake.

Success Of Cartilage Grafting with Mastoidectomy In Revision Tympanoplasty

Aims and Objectives: Candidates having non-cholesteatomatous chronic otitis media who have failed tympanoplasty in first attempt (graft used conchal or tragal cartilage) is at higher risk of failure in subsequent repair. The adjunctive use of mastoidectomy with cartilage tympanoplasty (tragal or conchal) in these patients has decreased the risk for subsequent failure. Aim of our study is to compare effect of mastoidectomy in revision cartilage tympanoplasty in terms of successful graft uptake, hearing improvement, and prevalence of other complications. The arguments in favor of mastoidectomy include the facts that the open mastoid cavity provides an improved volume and pressure buffer, rids the mastoid of diseased mucosa, and ensures adequate patency of the aditus (14– 16). Although this logic is sound and is supported in the literature, we believe that in many revision cases, reconstruction with a robust material such as cartilage provides the additional stability necessary to allow the middle ear and mastoid to revert naturally to a normalized environment.

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.

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.

Surgical Outcomes of Tympanoplasty with Various Graft Materials in Chronic Otitis Media: A Retrospective Cohort Study

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neoTM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Saccharin Test Time as a New Prognostic Predictor of Tympanoplasty.

In India, Chronic suppurative otitis media (CSOM) is a general public health issue leading to hearing loss which can be corrected surgically by Tympanoplasty. By applying predictors for a successful surgery the effectiveness of the surgery can be improved. In this study we aim to determine the usefulness of prognostic factors in predicting outcome of surgery for better patient compliance. 1. To compare MERI scores and saccharin test time in predicting graft uptake and hearing outcomes in Tympanoplasty surgery. A prospective study included all cases of mucosal type of CSOM of either sex according to the inclusion and exclusion criteria. Saccharin clearance time was used to assess Eustachian tube function and Pure Tone Audiometry has been done Pre-operatively to assess Hearing. Risk categories were assigned using MERI scoring chart and severity of disease assessed by otomicroscopy during surgery. Patients were post-operatively followed up to 6months. Outcomes were assessed using Graft uptake, Hearing improvement and for recurrence of infection, compared with different categories of MERI and Saccharin time. The overall graft uptake was 96.6%. 100% successful graft uptake was seen among normal eustachian tube function. Hearing improvement after surgery may be predicted by saccharin and MERI test. Abnormal Saccharin test shows guarded prognosis in predicting the success of middle ear surgeries. Based on the MERI score and saccharin clearance time, hearing benefit and Surgical success can be assessed and patients can be counselled prior surgery regarding the expected outcome.

TYMPANOPLASTY AND ITS OUTCOME IN VARIOUS AGE GROUPS USING THE MIDDLE EAR RISK INDEX SCALE AT A TERTIARY CARE CENTRE IN EASTERN NEPAL

Background: Tympanoplasty is done in cases of chronic otitis media. Middle Ear Risk Index (MERI) Scale is used to predict the outcome of tympanoplasty, based on various risk factors like otorrhoea, perforation, ossicular chain status, cholesteatoma, smoking and middle ear granuation/effusion. The objective of the study was to report the success rate of graft uptake, postoperative gain in hearing threshold and to find out the association of success to the different categories of MERI scale. Methods: A prospective study of 75 cases of chronic otitis media who underwent tympanoplasty, was done over one year. Convenience sampling method was done. Clinical and audiological evaluation was done pre- and post- operatively. Risk categorization based on MERI scale was done. Data were recorded and analyzed using SPSS 16. Results: Out of 75 cases, 39 (52%) cases were male and 36 (48%) were female. The mean age was 24.55 years±11.545. Overall, 53 (70.66%) cases had successful graft uptake. MERI 1-3 group had 82.6 % (38/46), MERI 4-7 group had 64.7 % (11/17) and MERI 8-12 group had only 33.33% (4/12) graft uptake, (p-value 0.003). Above-10-year age group had higher graft uptake rate and hearing gain. Graft acceptance was seen equal in dry or wet ear, and in unilateral or bilateral perforation. Conclusions: Tympanoplasty done in cases with lower MERI scale and more than 10 years age group was associated with higher graft acceptance. More than 10 years age group had better hearing gain. The status of middle ear, dry or wet and laterality of perforation had no association for graft acceptance.

Evaluation of graft uptake in underlay myringoplasty using dry and wet temporalis fascia graft

Chronic otitis media (COM) is a vital cause of deafness worldwide. Myringoplasty is one of the best treatment options for COM (inactive mucosal variety). Temporalis Fascia is the most favored grafting material among various autografts, which can be used as dry or wet depending upon the Surgeon's choice. The main focus of this study is to compare the graft uptake rate by using dry and wet temporalis fascia by underlay technique. This cross-sectional comparative study was directed from January 2018 to June 2019 at the Department of Otolaryngology-Head & Neck Surgery of BSMMU, Dhaka. All consecutive cases of COM (inactive mucosal) who underwent surgery were randomly assigned either into the dry (Group-A) or wet temporalis fascia group (Group-B). At 12 weeks follow-up, the density of graft failure (4.4% vs. 8.8%) and retraction pocket (0% vs. 2.2%) were higher in the wet procedure. However anterior blunting (2.2% vs. 2.2%) were the same in both procedures, and medialization (2.2% vs. 0%) were more in the dry procedure. Air Bone Gap (ABG) improved significantly in both groups following operation but reduced in Group-A more significantly than Group-B. On the other hand, there was no remarkable difference in successful graft uptake between the groups (Dry group-91.12% vs. wet group-84.44%, p>0.05). No graft material is superior to others in terms of graft uptake. BSMMU J 2022; 15(2): 84-89

The role of middle ear risk index on the outcome of surgery for chronic otitis media

<p><strong>Background: </strong>Chronic otitis media (COM) is a highly prevalent disease of the middle ear and constitutes a serious health problem worldwide, especially in developing countries. This study was done to evaluate the role of the middle ear risk index (MERI) on the outcome of surgeries for COM in the form of successful graft uptake and improvement in hearing.</p><p><strong>Methods:</strong> A total of 68 patients of COM were included in this study. Detailed ENT examination and preoperative pure tone audiometry were done in all patients. MERI score was calculated and patients were stratified based on the MERI score. All patients were evaluated at the end of 3 months postoperatively, for the status of graft uptake and improvement in hearing.</p><p><strong>Results:</strong> The MERI was found to be a remarkable predictor of the outcome of surgeries for COM. The patients with mild MERI scores had a significantly better prognosis than patients with severe MERI scores.</p><p><strong>Conclusions:</strong> MERI is a very useful and honest predictor of the graft uptake and hearing benefit in patients undergoing surgeries for COM. It has an inverse relation with graft uptake and hearing benefit. Based on the MERI score, the likelihood of surgical success and hearing benefit could be explained to the patient of COM to give them realistic expectations.</p>

CORRELATION OF EUSTACHIAN TUBE FUNCTION WITH TYMPANOPLASTY OUTCOME

Background– Eustachian tube play a vital role in the pathogenesis of middle ear cleft disease.Normal eustachian tube function (ETF) is responsible for successful tympanoplasty outcome. Pre operative ETF test should be done. Aim & objective– To evaluate the role of Eustachian tube function in successful graft uptake in tympanoplasty. Method – a prospective study was done on 50 patients, with mucosal type of chronic otitis media (COM). Eustachian tube function (ETF) was assessed with various methods like impedance audiometry (Toynbee's method),methylene blue dye test etc, and correlation of graft uptake with preoperative ETF was done. Result– Out of 50 patients,78% had normal tubal function and 22% had partially impaired tubal function. Tympanoplasty was successful in 92.3% patients with normal ETF and 54.5% patients with partially impaired ETF. Conclusion– There is a strong association between ETF and graft uptake.Thus,proving that eustachian tube plays a major role in the graft uptake.So preoperative ETF should be done.

Differential Tympanic membrane retraction

Aims and objectives: Tympanic membrane retraction occurs due to inadequate ventilation of middle ear cavity. The aim is to evaluate the surgical management of TM retractionits effectiveness and analyse the hearing improvement after surgery. Materials and methods: A retrospective study with 100 patients came to ENT OPD vmkvmch Salem in last 2 years with symptoms of hard of hearing, ear ache, ear block sensation. These patients underwent necessary ENT examination, diagnosed as TMwere selected for study and surgery done for these cases depending upon the grades of TM retraction which included Grommet insertion, Cartilage Tympanoplasty, Cortical Mastoidectomy + cartilage tympanoplasty. They were followed up for1, 3 and 6 months post operatively and evaluated based on hearing assessment after surgery and successful graft uptake. Results: Surgical interventionwas donedepending upon the stage of retraction. Grommet insertion done in stage 1, cartilage tympanoplasty in stage 2whereas stage 3 cortical mastoidectomy +cartilage tympanoplasty done. Hearing improvement seen after 1 month 76%,3 and 6months is 84% and 96%. The success rate in stage 1 retraction is 90 %, stage 2 84% and stage 3 81%.

A 5 YEAR PROSPECTIVE COMPARATIVE STUDY OF ENDOSCOPIC VERSUS MICROSCOPIC TYMPANOPLASTY IN A TERTIARY CARE CENTRE OF SOUTH INDIA.

CONTEXT: Type 1 tympanoplasty is one of the commonest performed surgeries by otolaryngologists across the world. Endoscopic ear surgeries (EES) are gaining more popularity in recent times. The objective of this study is to evaluate the outcomes of endoscopic type 1AIMS: tympanoplasty and compare with that of microscopic tympanoplasty A prospective observational comparative studySETTINGS AND DESIGN: of two surgical techniques was conducted in a tertiary care hospital of south India from 2015- 2019. All patientsMETHODS AND MATERIAL: underwent type 1 tympanoplasty either endoscopic or microscopic using temporalis fascia graft. S StatisticalTATISTICAL ANALYSIS USED: package for the social sciences (SPSS) version 17 was used to analyse the data. Chi square test/Fisher's exact test was used to analyse the qualitative data. Student t test was used to analyse the quantitative data A total of 152 patients who satised the study criteria were included in this. RESULTS: study. 80 patients underwent endoscopic tympanoplasty (Group A), while 72 patients microscopic tympanoplasty (Group B). Both the groups were comparable with respect to age gender, size and location of perforation. The mean operative time for group A and group B were 45.3 ± 7.1 and 50.2± 8.1 mins respectively (P=0.01). Successful graft uptake was observed in 75/80(93.75%) and 68/72(94.4%) in group A and group B (P= 0.45). Mean pre and post operative ABG were 30.2 ± 3.2 dB &29.8± 3.6 dB and 11.6± 1.8 dB & 11.9± 2 dB respectively (p= 0.32 and P=0.24). Group A had better post-operative VAS scores(P=0.01) and lesser canalplasty requirement(p=0.04) In this study, the hearing results ofCONCLUSIONS: endoscopic and microscopic tympanoplasty were comparable and no signicant difference was observed. However, endoscopic tympanoplasty had better outcomes in terms of lesser canalplasty requirement and post operative pain scores.

Evaluation of audiological profile and graft uptake by endoscopic composite cartilage graft tympanoplasty in chronic otitis media patients

<p class="abstract"><strong>Background:</strong> Transcanal endoscopic ear surgery (TEES) permits wide-angle vision, high resolution, and magnification as well as the direct visualization of hidden areas of the middle ear cavity. The aim of the study was to determine the anatomic and functional results of endoscopic composite cartilage tympanoplasty in chronic otitis media cases with safe central perforation.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted on 50 chronic otitis media cases with safe central perforation (small/medium) between February 2020 to July 2021 in a tertiary care center. All the patients were selected as per the described inclusion and exclusion criteria. All cases underwent endoscopic composite cartilage graft tympanoplasty (type-I) under general anesthesia. Audiological outcomes were assessed by comparing mean pure tone average pre-and post-operatively and morphological results (successful graft uptake) were evaluated at 6 months. </p><p class="abstract"><strong>Results:</strong> The result of this study showed that out of 50 cases 47 had successful graft uptake (94%) while 3 cases were found to have a residual perforation. The pre-operative air conduction threshold (ACT) was 42.82±7.33 dB whereas postoperative ACT was 31.26±7.48 dB, and the difference between the preoperative and postoperative values was found to be statistically significant. </p><p class="abstract"><strong>Conclusions:</strong> This study concluded that endoscopic composite cartilage tympanoplasty in chronic otitis media cases with dry central perforations is an effective surgical modality with good audiological and morphological outcomes and negligible post-operative complications.</p>

Comparison of Endoscopic Versus Microscopic Tympanoplasty.

Introduction:Tympanoplasty is a common surgery for chronic otitis media and has conventionally been performed with a microscope for decades. The trend of endoscopic minimally invasive surgeries has been increasing worldwide for the last few decades. Few studies have discussed the outcomes of tympanoplasty with microscope and tympanoplasty with endoscope . This study aims to compare results of tympanoplasty done with microscope vs endoscope in terms of graft take rate and improvement in conductive hearing loss.Materials and Methods:We did a retrospective review of 120 patients (54 male and 66 female) who underwent Type I tympanoplasty at Liaquat National Postgraduate Medical Center from January 2019 to January 2020. We included 60 patients who underwent tympanoplasty with microscope and 60 patients who underwent tympanoplasty with endoscope. Postoperative graft uptake and hearing improvement were studied.Results:Overall mean preoperative hearing loss was 30.24 (±9.61) dB as compared to mean postoperative hearing loss, which was reduced to 19.36 ( ±8.54) dB, and the difference was significant (P-value <0.001. No statistically significant difference was found for air-bone gap closure between the two groups (P-value 0.78). Out of 120 patients, overall successful graft uptake was seen in 109 (90.8%). In tympanoplasty with microscope, graft take was 90.0%, compared to 91.6% in endoscope group. There was no significant difference in graft take in the two groups.Conclusions:The tympanoplasty with endoscope is comparable to tympanoplasty with microscope in terms of graft uptake and hearing improvement.

Chronic Otitis Media (Squamous Disease): Clinical Predictors for Hearing Outcome

Introduction Postoperative hearing outcome after tympanomastoid surgery may sometimes be disappointing. This study aims to identify the factors influencing hearing outcome in squamous type of chronic otitis media (COM). Materials and Methods Prospective descriptive study on consecutive patients undergoing tympano-mastoidectomy for squamous COM. Results Analysis of 40 ears revealed that 10% had discharge less than one year with majority (75%) having more than three years. Pars flaccida and postero-superior pars tensa retraction pockets were most common findings with frank cholesteatoma only in 10%. Though mean preoperative pure tone average was significantly better (p=0.004) in those with ear discharge less than one year, 50% required type IV tympanoplasty, irrespective of duration of discharge. Type IV tympanoplasty revealed significant worsening of hearing (p=0.05), unlike type I-III where intact stapes suprastructure showed a significant postoperative improvement (p = 0.036). Successful graft uptake with discharge free ear was noted in 97.5% by 12 weeks. Conclusion Majority of our patients availed otolaryngologist opinion after more than three years of onset of discharge. Significant ossicular erosion occurs early in the disease. Preoperative better audiogram is not a predictor of ossicular status. Lack of significant symptoms and subtle clinical finding in the tympanic membrane, overlooked by the patient as well as the primary health care provider are confounding factors for early referral and surgical intervention by otolaryngologist. There appears to be a considerable delay for the common person in reaching the services of otolaryngologist; a relevant issue which need to be addressed at a national level to reduce the burden of the disease.

ASSESSMENT OF HEARING OUTCOME IN ENDOSCOPIC TYMPANOPLASTY BY UNDERLAY TECHNIQUE

AIM: To study the hearing outcome of “Endoscopic Tympanoplasty” by underlay technique. METHODS: This study includes 30 patients presenting with Chronic Suppurative Otitis MediaTubotympanic type. Preoperative assessment includes complete clinical history, thorough ENT examination, X-ray mastoids, Pure Tone Audiogram and routine investigations. Informed and written consent was obtained from all the patients. All the patients were subjected to endoscopic transcanal tympanoplasty by underlay technique using temporalis fascia. Patients were regularly followed up for a period of 3 months and at the end of 3 months pure tone audiogram was done to assess hearing. RESULTS: In our study of 30 patients postoperatively, 80% of the patients had successful graft uptake. In our study, postoperative air-bone gap closure was in the range of 0-10 dB in 55% of patients, 11-20 dB in 20% of patients, 21-30 dB in 5% of patients and 31-40 dB in 20% of patients. CONCLUSION: Transcanal Endoscopic Tympanoplasty is a minimally invasive surgical approach as the endoscope usage provides good exposure of tympanic membrane and improves the visualisation of middle ear structures without canaloplasty

The Emerging Surgical Concepts and Principles of Attic and Postero-Superior Wall Reconstruction by Auricular Cartilage and Free Fibro-Periosteal Tissue in Middle Ear Surgery. An Exposition on Surgical Experiences, Observations and Mistakes.

In middle ear surgeries, addressing the pathologies (cholesteatoma, retractions or tympanosclerosis) in attic or postero-superior area, are associated with difficulties like reconstruction of attic and postero-superior canal wall after clearing the disease. There are various graft materials available for such attic reconstruction in intact canal -wall surgeries. We describe our experience of attic and postero-superior canal wall reconstruction in combined approach tympanoplasty (CAT) using free auricular cartilage and free fibro-periosteal tissue and to present our results in anatomical and functional perspectives. This retrospective observational study was conducted in a tertiary care center which comprised 25 cases of combined approach tympanoplasty (with attic wall reconstruction) which were operated for attic cholesteatoma, tympanosclerosis or adhesive otitis media from January 2017 to December 2019 in our otolaryngology department. Outcomes were evaluated in audiological and morphological dimensions and paired "t" test (significant p value <0.05) was used to analyse the audiological data. A total of 25 cases (22 primary and 3 revision cases) were included in the study. Defect in attic and posterosuperior canal wall was caused by pathology (disease itself) in 2 cases, surgically created (intraoperatively to clear the disease) in 11 cases and both by pathology and surgically in 12 cases. 22 cases had successful graft uptake, with a morphological success rate of 88%, whereas graft failure was encountered in 3 cases. Complications observed were post-operative otorrhea (2 cases), recurrence (3 cases), no hearing improvement despite intact graft (1 case) and worsening of hearing post operatively in 1 case. Pre-operative ACT (Air conduction threshold) was 45.96 ± 12.47dB and the post-operative ACT was 38.61 ± 9.76dB (p value = 0.0246). Pre-operative ABG (Air-bone gap) was reduced from 30.58 ± 11.06dB to the post-operative ABG of 21.89 ± 6.24dB (p value = 0.0013). Reconstruction of postero-superior canal wall and attic defects in CAT using auricular cartilage and fibro-periosteal tissue (over mastoid cortex) is a novel method and associated with satisfactory morphological and audiological results. It is also effective in preventing postoperative retractions.

Results of tympanoplasty in reference to the condition of middle ear mucosa and edge of perforation in safe chronic otitis media

&lt;div class="Section1"&gt;&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Chronic suppurative otitis media (CSOM) is an important and a highly prevalent disease of the middle ear and poses serious health problem worldwide especially in developing countries where large percentage of the population lack specialized medical care, suffer from malnutrition and live in poor hygienic environmental conditions. Aim of the study was to study the outcome of tympanoplasty in the light of character of edge of perforation and middle ear mucosa condition.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This prospective study was conducted in 39 patients who underwent tympanoplasty in the department of ENT and head and neck surgery, Assam medical college and hospital, Dibrugarh between 1&lt;sup&gt;st&lt;/sup&gt; June 2019 to 31&lt;sup&gt;st&lt;/sup&gt; May 2020. Rim of perforated tympanic membrane and middle ear mucosa were sent for HPE. Three post-operatives follow up were done and surgical success was measured in terms of graft uptake and improvement in hearing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Out of 39 cases, successful graft uptake was seen in 33 (84.62%) cases. Extension of migration of squamous epithelium in the undersurface of tympanic membrane was found in all 6 cases (3 had complete epidermosis while 3 had partial). All the six graft failure cases had diseased middle ear mucosa, mostly infected hypertrophied mucosa and tympanosclerosis with infiltration of chronic inflammatory cells and 1 patient had keratosis flakes with vascular stroma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Hypertrophic changes with inflammation of middle ear mucosa and epidermosis on the medial surface of tympanic membrane was found to have negative influence on the tympanoplasty outcome.&lt;/p&gt;&lt;/div&gt;

Evaluating the outcome of type I Tympanoplasty with cortical mastoidectomy using temporalis fascia graft with and without tragal cartilage support

Type 1 tympanoplasty with graft helps in closure of perforation thereby arresting otorrhoea and improvement in hearing. Selecting a graft in tympanoplasty with cortical mastoidectomy is still a debatable topic among ENT surgeons across the world. Cortical mastoidectomy is opted by many for good mastoid ventilation and disease clearance in chronic otitis media.Evaluating postoperative outcomes of patients in graft uptake and hearing improvement in cortical mastoidectomy with type I tympanoplasty using temporalis fascia graft with and without tragal cartilage support in quiescent mucosal type of chronic otitis media with conductive hearing loss. A retrospective study of 60 patients who underwent cortical mastoidectomy with type I tympanoplasty were screened and taken for study. Group A had 30 patients who had underwent tympanoplasty with temporalis fascia supported by cartilage and group B included 30 patients who underwent tympanoplasty with temporalis fascia alone. They were followed periodically for 6 months and the outcome of graft uptake and hearing improvement were compared. Successful Graft uptake in group A was 90% and group B was 93%. Hearing improvement in group A was 83% and group B was 87%. Type I Tympanoplasty with cortical mastoidectomy gives a good outcome in terms of graft uptake and hearing improvement in chronic otitis media, but our study showed no significant difference between the two types of grafts used for tympanoplasties. The selection of patients, the condition of middle ear, postoperative asepsis and compliance of the patient and periodic follow up remains the crux in best outcome.