Successful Graft Uptake Research Articles

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

<div class="Section1"><p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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<sup>st</sup> June 2019 to 31<sup>st</sup> 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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p></div>

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.

Factors Affecting Graft Uptake of Large Wound Surface, Covered by Mesh Split Skin Grafting: A Longitudinal Study

Introduction: Skin grafting is one of the most indispensable techniques in surgery these days. In low resource settings, skin grafting using mesh, still forms the important technique of wound coverage. Aim: To evaluate the factors affecting graft uptake of large wound surface, covered by mesh split skin grafting on various postoperative days (day 5, day 10 and day 21). Materials and Methods: This prospective longitudinal study was conducted at Indira Gandhi Government Medical College and Hospital, Nagpur, Maharashtra, India, from June 2017 to December 2019, among patients with large wound surface. After baseline evaluation and wound preparation; patients were posted for mesh skin grafting. Postoperatively, the graft uptake percentage was assessed on the day 5, day 10 and day 21. Other parameters that were assessed were demographic details, mean stay of the patients during the preoperative and postoperative period, effect of various factors (age, gender, co-morbidities, addictions, site and aetiology of raw area, preoperative cultures) influencing graft uptake and postoperative complications. Statistical Package for Social Sciences (SPSS) version 20.0 was used for statistical analysis. Results: A total of 117 patients were enrolled in the study, out of which, 97 (82.9%) of the patients were males. The most common raw area was seen in lower limbs and accounted for 98 patients (79.1%) and the most common cause of raw area was cellulitis (n=91). Out of 117 patients, 105 (89.7%) had successful graft uptake on postoperative day 5, 102 patients (87.2%) on day 10 and 100 patients (85.4%) on day 21. Whereas, 17 (14.5%) patients had failed uptake of graft on postoperative day 21. It was observed that age (p-value=0.04) and preoperative cultures (p-value=0.01) were statistically significant factors influencing graft uptake. Conclusion: The present study reports mesh split skin grafting, a reliable and useful technique with successful graft uptake. Hence, it can be considered for the management of large raw areas.

A comparative study to assess the graft uptake in patients undergoing postauricular tympanoplasty using temporalis fascia vs sliced tragal cartilage

context: Tympanoplasty is a surgical procedure to repair tympanic membrane perforation and reconstruct the tympanic membrane and hearing, commonly done after chronic suppurative otitis media and trauma. Aims: To comparatively study the graft uptake in patients undergoing type 1 tympanoplasty using temporalis fascia vs sliced tragal cartilage Settings and Design: The study was a prospective case-control study carried out in the department of ENT, D.Y.Patil medical college, Pimpri Methods and Material: 50 patients undergoing tympanoplasty were divided into 2 groups randomly and operated using Temporalis fascia(TF) in 25 patients and Sliced tragal cartilage(STC) graft in the rest 25 patients. All cases were operated under local anesthesia. A post aural approach was implemented for the surgery. 25 patients were subjected to tympanic membrane repair with temporalis fascia graft and the remaining 25 with Tragal cartilage graft. For tragal cartilage graft incision was taken over the undersurface of the tragus and the obtained tragal cartilage was sliced to a thickness of 0.5 to 1.0 mm. Results: The mean duration of symptoms was 12.72 and 15.84 months in groups A and B respectively. A successful graft uptake was noted in 21(84%) patients in the TF group whereas it was noted in 24 patients in the STC group (96%). There was permanent perforation noted in 4 (16%) patients in the TF group and 1 (4%) patient in the STC group. The difference was non-significant with a P-value of 0.157 Conclusions: In the clinical study performed, postauricular tympanoplasty using the Sliced tragal cartilage was associated with better graft uptake and hence can be regularly employed for tympanic membrane repair compared to Temporalis fascia.

Comparison of Tragal Cartilage and Conchal Cartilage in Tympanoplasty

Aim and Objectives: The aim and objective of the study are to compare results in terms of graft uptake and hearing improvement in cases undergoing tympanoplasty with the use of conchal or tragal cartilage. Materials and Methods: A total of 74 cases of more than 18 and <50 years of age included in this study, where full-thickness cartilage tympanoplasty was performed. Thirty-seven cases included in Group A where tragal full-thickness cartilage was used and 37 cases included in Group B where full-thickness conchal cartilage was used. Results: Thirty-six (97.3%) cases in Group A and 35 (94.6%) cases in Group B had successful and complete graft uptake in this study. Hearing improvement was found to be better with the cases in Group B than Group A. Conclusion: Full-thickness conchal cartilage and tragal cartilage give good graft uptake results and hearing improvement is significantly better with the use of conchal cartilage.

ROLE OF FIBRIN GLUE FOR BETTER SUCCESS RATE IN MYRINGOPLASTY

Objective: To see graft uptake success rate in platelet rich fibrin aided underlay myringoplasties using temporalis fascia graft compared to conventional underlay myringoplasties.
 Study Design: Double blind randomized controlled trial study.
 Place and Duration of Study: ENT department, Pakistan Naval Ship Shifa Hospital, from Jan to Jun 2019.
 Methodology: Sixty cases with dry central tympanic membrane perforations were recruited. The patients suffering from sensori-neural hearing loss and co-morbidities like diabetes were excluded. The sampling technique was probability simple random. Patients were divided into two groups by lottery method. Statistical analysis was performed by using SPSS. The chi square test was applied to calculate p-value.
 Results: Out of total 60 patients 38 were males and 22 were females. Study group’s (Fibrin) mean age was 31.77 ± 12.43 years and Control group’s mean age was 27.53 ± 11.41 years. All the patients in platelet rich fibrin group had successful graft uptake at 2 months follow-up. In control group with conventional technique 23 out of 30 patients had successful graft uptake and rest 7 patients had different issues leading to graft rejection.
 Conclusion: In under lay myringoplasty procedure, application of platelet rich fibrin on temporalis fascia graft edge and perforation edges has significantly improved the successful uptake rate of graft.

Fat graft myringoplasty: A clinical study and review of literature

Objectives: There are numerous surgical techniques that have been demonstrated and utilized to repair small perforations in the tympanic membrane (TM) with various graft materials such as veins, perichondrium, periosteum, and others. In our study, fat was taken as the graft material and the main aim of the study was to evaluate the success rate of graft uptake, assessment of hearing improvement, and complications of the operative procedure. Material and Methods: In this single-center study, 46 patients underwent fat myringoplasty, 52 ears were operated from October 2016 to September 2017 for a period of 1 year. A detailed history, general physical, and a through ear, nose, and throat examination were done. Audiometric assessment was done using pure tone audiometry. Patients between the age group of 15 and 50 years were included in the study. Results: A total of 46 patients were included in the study who met the inclusion criteria. Six patients had bilateral perforations and 40 patients had unilateral perforation, a total of 52 perforations were operated. Forty-three (82.69%) patients had successful graft uptake and graft failure was seen in 9 (17.30%) patients. Maximum gain in hearing was seen in in patients with hearing loss between 20 and 30 dB, that is, 24 patients (46.1%). Conclusion: Fat myringoplasty is a methodized, precise, inexpensive, mini-invasive, and cosmetic outpatient procedure for small perforations of TM. It can be done under local anesthesia and has a good success rate if the patient selection is done appropriately.

A Comparative Study on Outcomes of Type 1 Underlay Tympanoplasty with and Without Anterior Tucking of Temporals Fascia Graft.

Tympanoplasty is a surgical procedure which includes eradication of disease from the middle ear and reconstruction of the hearing mechanism with or without tympanic membrane repair. The purpose of this article was to compare the clinical and audiological outcomes of Type 1 underlay tympanoplasty with or without anterior tucking of the temporals fascia graft. This is a prospective interventional study which included 100 patients between 15 and 60years of age, diagnosed with chronic otitis media, mucosal disease inactive stage. 100 patients were divided into two groups 50 each, who underwent type 1 underlay tympanoplasty, group A underwent anterior tucking of the temporals fascia graft and group B without anterior tucking of the temporals fascia graft. Analysis of data was made of the demographic details, graft uptake status and audiological outcomes following surgery. Among the 100 patients included in the study, majority were seen between 21 and 40years of age group. In our study successful graft uptake was seen in 93.4% in group A temporalis fascia with anterior tucking which was better than group B which showed 84% results. However hearing outcome was almost similar in both the groups. In conclusion, graft uptake in tympanoplasty with anterior tucking was found to be better than without anterior tucking. There is significant hearing improvement following underlay technique of tympanoplasty both with and without anterior tucking. There is no significant difference in the hearing improvement with anterior tucking when compared to without anterior tucking of the temporalis fascia graft.

Comparative study of outcomes of type 1 tympanoplasty with and without anterior tucking

<p class="abstract"><strong>Background:</strong> Type-1 tympanoplasty is the functional restoration of the normal middle ear by repairing the tympanic membrane (TM). Different techniques are still evolving to devise a way to give optimal graft uptake and hearing improvement with minimal instrumentation. Various studies have been done to assess the role of anterior tucking in type-1 tympanoplasty and to assess its superiority over other methods in repairing subtotal perforations and large perforations involving the anterior quadrant.</p><p class="abstract"><strong>Methods:</strong> This study was done to compare the outcomes of endoscopic type-1 tympanoplasty with and without anterior tucking. 60 cases of chronic otitis media (COM) mucosal type were divided into 2 groups of 30 patients each. Group 1 underwent endoscopic type-1 tympanoplasty with anterior tucking and group 2 underwent endoscopic type-1 tympanoplasty without anterior tucking. The outcomes were evaluated after 6 months and compared in terms of graft uptake and hearing gain.</p><p class="abstract"><strong>Results:</strong> The mean air-bone gap improvement was 13.16±2.65 in group 1 and 12.90±3.78 in group 2, which had statistically insignificant differences indicating similar hearing outcomes in both the groups. 96.7% successful graft uptake was achieved in group 1 and 90% in group 2, showing statistically insignificant differences indicating similar graft uptake rates in both the groups.</p><p><strong>Conclusions:</strong> Anterior tucking with endoscopic type-1 tympanoplasty could provide good graft support and efficient hearing improvement but cannot be labelled as a mandatory step in repairing subtotal perforations or large perforations involving anterior quadrant as the outcomes are comparable to the endoscopic type-1 tympanoplasty done without anterior tucking. </p>

Myringoplasty in wet and dry ears: an observational study in a tertiary care center

<p class="abstract"><strong>Background: </strong>Chronic otitis media is the most common cause of hearing impairment in the developing countries with serious effects. The aim of the study was to compare the outcome of myringoplasty in dry and wet ears in tubo-tympanic type of chronic otitis media (COM) with respect to graft uptake and hearing improvement.</p><p class="abstract"><strong>Methods:</strong> This is an observational study done in the department of ENT, Mamata medical college, Khammam, during the study period of September 2019 to February 2021 on 40 patients of tubo-tympanic type COM. On simple random basis selected patients underwent myringoplasty by underlay technique. All patients were evaluated during post-operative follow-up.</p><p class="abstract"><strong>Results:</strong> In our study, majority of patients were in the age group of 26 to 45 years with slight female preponderance, with male to female ratio (0.73:1). In our study, the successful graft uptake was seen 90% in dry ears and 85% in wet ears, which seems to be not significant in difference. With respect to hearing improvement, post-operatively there was significant improvement in both the groups, when compared to pre-operative hearing. The maximum improvement in average hearing threshold after surgery, in dry ears with large perforation (12.66dB) and in wet ears with small central perforation (12.44dB) was almost equal.</p><p><strong>Conclusions: </strong>In this study, the success rate of graft uptake and hearing improvement is found almost equal in dry and wet ears by using underlay technique of myringoplasty. </p>

Pre-operative and post-operative audiological evaluation of type 1 tympanoplasty and comparison between temporalis fascia graft and tragal perichondrium graft

<p><strong>Background: </strong>Aim of the study was<strong> </strong>to evaluate the hearing improvement of type 1 tympanoplasty performed by using autologous temporalis fascia and autologous tragal perichondrium graft in successfully operated and graft uptake cases, with respect to age, sex, size of perforation and type of graft.</p><p><strong>Methods:</strong> This prospective study consists of total 100 patients with chronic suppurative otitis media (CSOM) tubotympanic disease who have undergone type 1 tympanoplasty. Randomization of patients was done. Every alternate patient was divided accordingly in to two groups-one in temporalis fascia graft group and another in tragal perichondrium graft group. Pure tone audiometry (PTA) was performed preoperatively and 3 months after surgery. Cases with successful graft uptake were included in the study. Statistical comparisons were performed using the t test, and ANOVA test.</p><p><strong>Results: </strong>In this study maximum numbers of patients were found in the age group of 15-30 years. Study showed that audiological benefits were more in males in comparison to females. Large size of perforation showed more improvement due to more air bone gap in comparison to medium size and small size perforation of ears. Audiological improvement occurred in 94% of cases, 3% cases worsened and 3% cases showed no change. More improvement was found in temporalis fascia graft in comparison to tragal perichondrium graft.</p><p><strong>Conclusions: </strong>Type 1 tympanoplasty is a safe and effective technique to improve the quality of life of patients. Size of perforation, type of graft was found to have a major effect on the final outcome of surgery.</p>

A study to evaluate and compare the outcomes of endoscope versus microscope assisted myringoplasty

<p class="abstract"><strong>Background:</strong> In microscope assisted middle ear procedures surgeons can only observe the parts of the tympanic cavity, the hidden areas, such as the facial recess and sinus tympani, would not be visualised which needs to be exposed for performing tympanoplasty. The aim of the study was to compare the outcomes of microscope versus endoscope assisted myringoplasties in terms of duration of the procedure, graft take up, improvement in hearing and incidence of any complications.</p><p class="abstract"><strong>Methods:</strong> A prospective comparative study was conducted for a period of one year. A total of 72 patients with CSOM were randomised into two groups of 36 each. Group A patients (n=36) underwent traditional myringoplasty under a microscope and group B patients (n=36) endoscopic assisted myringoplasty was performed. Post-operatively all the patients were followed up for a period of one year. During the follow-up period patients were assessed for the graft take up, hearing improvement, incidence of complications and recurrence rate between the two groups.</p><p class="abstract"><strong>Results:</strong> Successful graft uptake was observed in 88.8% among patients underwent microscope assisted myringoplasty and it was 94.4% in endoscopic assisted myringoplasty. The mean duration of surgery was 123 mins in microscopic assisted group compared to 92 mins in endoscopic assisted group and the difference was found to be statistically significant. Similarly, the cosmetic results and the post-operative pain were more favorable for endoscopic assisted group than microscopic assisted group and the difference was found to be statistically significant.</p><p class="abstract"><strong>Conclusions:</strong> Enoscopic assisted procedure could be considered as a better alternative for microscopic assisted myringoplasty.</p>

Role of Tympanoplasty on Eustachian Tube Dysfunction in Chronic Otitis Media – Mucosal Disease

Aim: To assess the Eustachian tube function (ETF) in chronic otitis media (COM)-mucosal disease and the role of tympanoplasty in ETF. Materials and Methods: A longitudinal study from January 2019 to June 2020 which comprised of 110 patients diagnosed with COM– mucosal disease was carried out in a tertiary care referral hospital. They were divided into mucosal active (n = 34) and mucosal inactive (n = 76) groups. Preoperative ETF was assessed with immittance audiometry by Toynbee's method. All patients underwent tympanoplasty with or without cortical mastoidectomy depending on the disease status. Postoperatively between 8 and 12 weeks after successful graft uptake, ETF was tested by William's test. Results: Out of 110 patients, 29 had Eustachian tube dysfunction preoperatively and 27 had normal ETF posttympanoplasty ± cortical mastoidectomy. Mc Nemer test was applied and P value was found to be < 0.01 denoting a highly significant difference between the pre and postoperative ETF. Conclusion: Tympanoplasty with or without cortical mastoidectomy has a therapeutic effect on ET dysfunction in COM-mucosal disease.

Evaluation of the role of middle ear risk index as a prognostic tool in cases of tympanoplasty in chronic suppurative otitis media

<p class="abstract"><strong>Background:</strong> In chronic suppurative otitis media (CSOM), the success rate of tympanoplasty, can range from 35% to 92% and is influenced by a number of factors such as age of patient, size and site of perforation, status of ear, ossicular status and surgical technique. The middle ear risk index (MERI) of a CSOM patient is an effective numerical grading system helpful in predicting the outcome of surgery. </p><p class="abstract"><strong>Methods:</strong> A prospective observational study was conducted in 50 patients over a period of 1 year including all cases of CSOM in age group of 18-55 years with conductive hearing loss that underwent tympanoplasty with or without cortical mastoidectomy and role of MERI was analysed for the outcome of the surgery. </p><p class="abstract"><strong>Results:</strong> Successful graft uptake was seen in 92% cases while in 8% cases graft was rejected. Of these 46 cases, 32 cases had mild MERI score, 10 had moderate MERI score and 4 had severe MERI score. It was observed that higher the MERI score, lower the graft uptake. </p><p class="abstract"><strong>Conclusions:</strong> Our study comprised of 50 patients of CSOM which were categorized into mild, moderate and severe on the basis of MERI score preoperatively. All the patients underwent tympanoplasty with or without cortical mastoidectomy and surgical outcome in terms of graft uptake was found to be significant. Higher the MERI score, lower was the graft uptake while lower the MERI score, higher was the graft uptake. Hence, MERI is a useful tool to ascertain the prognosis of tympanoplasty.</p>

Tympanoplasty for Wet and Dry Perforation: A Prospective Comparative Study

Introduction Two types of surgical procedures are performed for the treatment of Chronic otitis media (COM) mucosal disease, namely myringoplasty and tympanoplasty. In the present study, an objective, comparative evaluation between the outcomes of tympanoplasty, performed in the ‘wet ear’ and the ‘dry (non- discharging) ear’ has been undertaken. Materials and Methods A prospective study was conducted in a peripheral referral institute over a period of 37 months wherein a total of 105 patients with tympanic membrane perforation were selected, amongst which 56 patients had moist ear and 49 patients had dry ear. All of the patients underwent tympanoplasty by underlay technique. Final results were analyzed 12 months post operatively. Results In the wet ear group amongst 56 patients, 51 patients had successful graft uptake (91.07%). In dry ear group, among 49 patients, successful graft uptake was seen in 44 cases (89.79%). In the wet ear group 50 out of 56 patients had hearing improvement (89.28%). In dry ear group 44 out of 49 patients had hearing improvement (89.79%). Statistically significant results were obtained postoperatively in each group; however, inter group analyses showed no statistical significance. Conclusion Success rate of tympanoplasty does not depend upon the wet or dry state of middle ear at the time of surgery.

Comparative study between fat plug and inlay butterfly cartilage grafts for myringoplasty in adults

BackgroundThis study aims to compare the graft uptake rate and hearing improvement of fat graft versus inlay butterfly tragal cartilage in the repair of perforations in chronic otitis media mucosal in adults.In this retrospective study, twenty-eight patients were included with small dry anteroinferior tympanic membrane perforations (less than 1/3 of the tympanic membrane). The age range was 18 to 44 years old. Myringoplasty was done under general anesthesia for 8 patients with a fat graft (FG) and 20 patients with inlay butterfly cartilage graft (IBCG). Six months postoperatively, a follow-up evaluation was done for successful graft uptake and hearing outcomes.ResultsThe success rate of graft uptake in the first group (fat graft) was 6/8 cases (75%) while in the second group (IBCG) was 19/20 (95%) with no statistically significant difference (P = 0.0148). Also, there was no statistical difference between the two groups as regards postoperative ABG, improvement changes in ABG, and number of patients with improved hearing.ConclusionsInlay butterfly cartilage graft is a useful graft in repairing small tympanic membrane perforations as regard graft take and hearing outcomes.

Comparison between Outcome of Myringoplasty with and without Ensuring the Patency of Aditus ad Antrum

Background: Myringoplasty is a technique for the closure of the simple perforation of the tympanic membrane. For the better outcome, myringoplasty combined with cortical mastoidectomy has been tried in many studies. Objectives: To compare the outcome of repair of tympanic membrane perforations with myringoplasty alone versus myringoplasty with opening of blocked aditus if any by doing antrostomy. Methodology: This was a prospective study. Patients included in the study were randomly allocated into 2 groups, the group I and the group II. The group I included 17 patients undergoing myringoplasty with antrostomy and the group II included 17 patients undergoing only myringoplasty. The blocked aditus was made patent if it was found blocked during antrostomy procedure. Graft uptake rate and improvement in conductive hearing loss were measured as success rate. Results: Mean age of the patients in the group I was 23.12 ± 7.55 years. The mean age of patients in the group II was 25.53 ± 8.79 years. In the group I unilateral disease was present in 6 (35%) cases. In the group II unilateral disease was present in 12 (70.5%) cases. In the group I subtotal perforation was present in 9 (52.9%) cases and moderate to large perforation was present in 8 (47%) cases. In the group II subtotal perforation and moderate to large perforation were present in 9 (52.9%) and 8 (47%) cases respectively. Aditus was found to be blocked in eleven (64.7%) patients in the group I. Successful graft uptake was seen in twelve cases (70.58%) in the group I and eleven cases (64.7%) in the group II with all of them showing improvement in hearing. The success rate of the group I was 70.58% while success rate of the group II was 64.7%. The mean of pre-operative and post-operative air-bone gap was 31.94 ± 11.7 dB and 24.8 ± 10.55 dB respectively in the group I with the mean hearing gain of 7.06 ± 3.9 dB. Similarly, the mean of pre-operative and post-operative air-bone gap was 28.24 ± 10.5 dB and 17.9 ± 0.08 dB respectively in the second group with the mean hearing gain of 10.29 ± 4.83 dB. Conclusion: There was no difference between success rate of myringoplasty with antrostomy group and myringoplasty alone group in the treatment of mucosal tympanic membrane perforation; however in majority of cases where aditus patency was checked (group I) it was found to be blocked (64.7%).

Effectiveness of underlay myringoplasty in inactive mucosal chronic otitis media; a prospective study

Introduction: Patients with a mucosal type of chronic otitis media (COM) usually have recurrent ear discharge and conductive hearing loss. It is characterized by the central perforation of the tympanic membrane. Myringoplasty is an operation performed to repair tympanic membrane perforation when there is no ossicular damage. It helps to prevent ear discharge and improves hearing. Different techniques used for myringoplasty are underlay and overlay. Underlay technique is an effective procedure for tympanic membrane repair. Methods: 125 patients who underwent underlay myringoplasty over two years in a tertiary care center in Kerala were included in the study. Patients with actively discharging ears were excluded from the study. Results: The majority of the patients were in the age group of 20-29 years (49.6%). There were 47 males (37.6%) and 78 females (62.4%). In 63 patients the surgery was done on the right side (50.4%) and in 62 patients on the left side (49.6%). Maximum preoperative hearing loss was in the range of 30-34 dB (39.2%). 100 patients (80%) showed successful graft uptake with the improvement of hearing in the range of 10-15 dB. Eight patients (6.4%) showed small residual perforation with the improvement of hearing. In 17 patients (13.6%) there was a complete rejection of graft with continuous ear discharge and no improvement in hearing. Conclusion: Underlay myringoplasty is an effective surgical technique for the repair of tympanic membrane perforations in terms of graft take up and improvement of hearing.

Air bone closure and graft uptake, vis a vis tympanic reconstitution

<p class="abstract"><strong>Background:</strong> Tympanoplasty involves reconstitution of the tympano-ossicular system with commonly. fascia of the temporalis muscle, situated in its proximity. The fascia is grafted on the residual tympanic membrane by placing it either over it or below it, after creating a raw surface. The former is the overlay and latter, the underlay technique. In this study on restitution of the ear drum utilizing the overlay and underlay techniques, an exhaustive analysis of the two modalities has been done, taking into consideration various variables individually. The surgical outcome wrt to graft uptake and hearing gain has been compared in "depth" with extensive studies undertaken in India and abroad. The unbiased tabulated comparison of each aspect is unique and would guide future researchers to opt the ideal modality.</p><p class="abstract"><strong>Methods:</strong> Tympanoplasty was undertaken in chronic safe suppurative otitis media with the underlay and overlay techniques in a study group of 40 patients in this prospective study. The patients were randomly divided into equal groups for either procedure. </p><p class="abstract"><strong>Results:</strong> In the cohort of 40 subjects successful graft uptake was observed in 16 (80%) with overlay technique and 17 (85%) with underlay technique. Graft rejection was reported in 4 (20%) and 3 (15%) cases with overlay and underlay techniques respectively. Hearing improvement was 56.25% in 10-20 dB range in Overlay. Whereas, with underlay it was 47.05% in 10-2 dB.</p><p class="abstract"><strong>Conclusions:</strong> Overlay technique is ideal for anterior and central perforations while underlay for subtotal and posterior perforations. In terms of hearing improvement, the fibrosis during graft uptake makes the results of either technique unpredictable.</p>

Do mastoidectomy and type of graft affect tympanoplasty outcome in Egyptian children? A prospective randomized study

BackgroundThe purpose of this study is to evaluate and compare surgical and hearing outcomes of tympanoplasty using temporalis fascia graft and tragal cartilage with or without mastoidectomy in children with tubotympanic chronic suppurative otitis media.Two hundred children with chronic suppurative otitis media of tubotympanic type with perforation were included in this prospective randomized study. They were divided randomly into four equal groups according to operation done. Group I underwent tympanoplasty using temporalis fascia graft with cortical mastoidectomy, while in the second group, tragal cartilage was used as a graft with mastoidectomy. Groups III and IV were done without mastoidectomy, with tragal cartilage for group III and temporalis fascia for group IV. One-year follow-up was done for all patients to evaluate graft success (means without perforation nor retraction). Audiological evaluation was done for all children preoperatively and 6 months postoperatively for patients with successful graft uptake.ResultThere were 170 patients (85%) with graft success postoperatively. Tympanoplasty using temporalis fascia graft showed highly statistically significant difference (P < 0.001) when compared to tragal cartilage as regards hearing improvement in patients with successful graft uptake, while there is no statistically significant difference as regards graft uptake (P = 0.039). Also, there is no statistically significant difference between different techniques with or without mastoidectomy (P = 0.165).ConclusionTympanoplasty using temporalis fascia without cortical mastoidectomy is the surgery of choice in children between 10 and 16 years old with tympanic membrane perforation as it showed highly statistically significant difference when compared to tragal cartilage graft as regards hearing improvement, with no statistically significant difference regarding successfully graft uptake.