Treatment Of Chronic Otitis Media Research Articles

Multimodal additive manufacturing of biomimetic tympanic membrane replacements with near tissue-like acousto-mechanical and biological properties

The three additive manufacturing techniques fused deposition modeling, gel plotting and melt electrowriting were combined to develop a mimicry of the tympanic membrane (TM) to tackle large TM perforations caused by chronic otitis media. The mimicry of the collagen fiber orientation of the TM was accompanied by a study of multiple funnel-shaped mimics of the TM morphology, resulting in mechanical and acoustic properties similar to those of the eardrum. For the different 3D printing techniques used, the process parameters were optimized to allow reasonable microfiber arrangements within the melt electrowriting setup. Interestingly, the fiber pattern was less important for the acousto-mechanical properties than the overall morphology. Furthermore, the behavior of keratinocytes and fibroblasts is crucial for the repair of the TM, and an in vitro study showed a high biocompatibility of both primary cell types while mimicking the respective cell layers of the TM. A simulation of the in vivo ingrowth of both cell types resulted in a cell growth orientation similar to the original collagen fiber orientation of the TM. Overall, the combined approach showed all the necessary parameters to support the growth of a neo-epithelial layer with a similar structure and morphology to the original membrane. It therefore offers a suitable alternative to autologous materials for the treatment of chronic otitis media. Statement of significanceMillions of people worldwide suffer from chronic middle ear infections. Although the tympanic membrane (TM) can be reconstructed with autologous materials, the grafts used for this purpose require extensive manual preparation during surgery. This affects not only the hearing ability but also the stability of the reconstructed TM, especially in the case of full TM reconstruction. The synthetic alternative presented here mimicked not only the fibrous structure of the TM but also its morphology, resulting in similar acousto-mechanical properties. Furthermore, its high biocompatibility supported the migration of keratinocytes and fibroblasts to form a neo-epithelial layer. Overall, this completely new TM replacement was achieved by combining three different additive manufacturing processes.

Endoscopic Tympanoplasty as an Alternative to Microscopic Tympanoplasty: A Comparative Study on Surgical Outcomes and patient satisfaction.

Chronic otitis media treatment has evolved, with microscopic surgeries as the gold standard and endoscopic surgeries as a newer addition. This retrospective study includes 209 patients who underwent type 1 tympanoplasty, utilizing both endoscopic and microscopic techniques, between January 2019 and December 2022 at a tertiary care institute in India. The study aims to compare hearing outcomes, graft uptake, hospital stay, postoperative pain, and cosmesis between the two groups. Mean AB gap closure was 17.09 + 5.98 dB in the endoscopic group and 16.74 + 5.05 dB in the microscopic group (P = 0.687). The duration of surgery was 79.26 ± 17.37min in the Endoscopic group and 91.92 ± 15.35min in the Microscopic group. (P = < 0.00001). The Endoscopic group experienced less post-operative pain, shorter hospital stay (P = < 0.00001, P = 0.0008), and exhibited better cosmetic outcomes (P = 0.00001) compared to the microscopic group. Endoscopic tympanoplasty is a better alternative to microscopic tympanoplasty, delivering comparable hearing outcomes, shorter surgical duration, improved pain scores, and better cosmesis. The online version contains supplementary material available at 10.1007/s12070-023-04184-4.

Classification of pathological epidermization (cholesteatoma) of the middle ear NMAO

The periodicals published over the past 5 years showed that interest in the issue of surgical treatment of chronic otitis media, including one complicated by cholesteatoma, did not wane despite the large accumulated experience of schools in otosurgery around the globe. In our opinion, there are currently some significant problems of terminology in the clinical anatomy of the ear, in particular, the nomenclature of the upper floor of tympanic cavity, which negatively affects the comparison and reproducibility of the results of surgical treatment of chronic otitis media. The critical analysis of the current classification of middle ear cholesteatoma proposed in 2017 and validated in Russia in 2021 demonstrates certain difficulties in using the pathohistological term “cholesteatoma”, as well as the basic inaccuracy in defining the concept and structure of the anterior parts of the epitympanum. The work aims to develop and present a new classification of pathological middle ear epidermization (cholesteatoma), which is based on the pathophysiology of middle ear ventilation. The modern concepts on the mechanisms of middle ear ventilation reveal its important role in developing the pathological epidermization and secondary cholesteatoma. The use of three-dimensional modelling of airway ventilation makes it substantially easier to follow the pathophysiological mechanisms of development of tympanic membrane retraction. The tympanic diaphragm consists of more than 10 composite elements. Understanding the pathophysiological principles underlies the proposed classification of pathological middle ear epidermization (cholesteatoma), which is based on the prevalence of middle ear and surrounding anatomical formation injuries. The pathological process area is coded using the abbreviation of the National Medical Association of Otorhinolaryngologists. In this abbreviation, each letter corresponds to a specific anatomical region. The tympanic diaphragm represents the boundary between the regions. Each letter is assigned an index corresponding to the degree of pathological epidermization invasion into the structures of the middle ear, temporal bone and cranial cavity. The authors provide a table, which serves as a visual aid for ease of coding the diagnosis. Examples of how to formulate a diagnosis in accordance with otoscopic illustrations are given.

Evaluation of the surgical treatment results of chronic otitis media with tympanic membrane perforation

Objectives: To describe the clinical and paraclinical characteristics of chronic otitis media with tympanic membrane perforation and evaluate the results of surgical treatment of chronic otitis media with perforation. Materials and methods: 75 patients were diagnosed with chronic otitis media with perforation and underwent surgery at the Hue University of Medicine and Pharmacy Hospital and Hue Central Hospital from May 2020 to September 2021. Results: The disease was more common in women, mainly in the age group of 16-30 years old (34.7%). Common preoperative symptoms are hearing loss and tinnitus. The main reason for surgery was a history of prolonged otorrhea (50.7%). The primary location of the tympanic membrane perforation is central (74.7%). The symptoms of hearing loss and tinnitus in patients after myringoplasty improved significantly compared to before surgery. The average hearing after myringoplasty and attico-antrostomy surgery improved statistically significantly compared to before surgery. The overall anatomical outcome after surgery was good, accounting for the majority with the rate of 86.7%. Conclusion: Chronic otitis media is a common disease with a long duration and affects life quality. Surgical treatment for chronic otitis media is safe and effective. Key words: Chronic otitis media, tympanic membrane perforation.

Polish national guidelines for the diagnosis and treatment of chronic otitis media with effusion in children.

Otitis media with effusion (OME), is a common childhood disease and is characterized by long-term fluid retention in the middle ear spaces without signs of acute infection. Surgical treatment of OME in the form of a tympanostomy is one of the most commonly performed medical procedures by pediatric ENT surgeons worldwide. In February 2022, the Journal of Otolaryngology - Head and Neck Surgery published updated guidelines from the American Academy of Otolaryngology - Head and Neck Surgery for tympanostomy tuba in children between 6 months and 12 years of age. They are aimed at both otolaryngologists and pediatricians, as well as other medical personnel who are directly involved in the care of patients with tympanostomy tuba or are candidates for the procedure. The previous version of the guidelines was developed in 2013. With the cooperation of the Board of Expert chaired by the National Consultant in Pediatric Otorhinolaryngology, Prof. Wieslaw Konopka, PhD, during the VII International Conference &quot;Otology, 2022&quot; which took place on September 15-17, 2022 in Torun, the previously published recommendations and consensuses from other countries, both European and non-European, were analyzed and the task of developing new national diagnostic and therapeutic recommendations for OME was undertaken.

A comparative study of endoscopic versus microscopic tympanoplasty in chronic otitis media

Background: To compare the results between tympanoplasty performed with transcanal endoscopic ear surgery and microscopic ear surgery for the treatment of chronic otitis media. Materials and Methods: A double-blind randomized prospective study was performed on inactive chronic otitis media patients that underwent tympanoplasty and later follow-up for at least 6 months in terms of graft uptake and hearing gain. Seventy patients were selected and randomized in Group A-endoscopic tympanoplasty and Group B-microscopic tympanoplasty. Results: In our study, we found that the graft take up rate was 94.3% (33/35) in Group A and 91.4% (32/35) in Group B. The improvements in the air-conduction levels and the air-bone gaps were not significantly different between the two groups (P > 0.05). The average hearing gains in the endoscopic group postsurgery were 10.51 ± 4.71 dB and in the microscopic group were 12.23 ± 4.72 dB (P = 0.132). The average operating time was 37.77 ± 5.33 min in the endoscopic group which was better than the microscopic group which was 45.77 ± 5.29 min, (P < 0.001). Conclusion: Endoscopic tympanoplasty technique is a feasible alternative to the conventional microscopic technique owing to the findings in terms of duration of surgery and graft uptake. In addition, the endoscopic approach provides better postoperative cosmesis, patient satisfaction, and early mobilization.

A Comparative Study of Endoscopic and Microscopic Tympanoplasties Using Temporalis Fascia Graft

Background: Chronic otitis media (COM) is a widespread disease in developing countries. Tympanoplasty is one of the common procedures in otorhinolaryngology for the treatment of COM. It can be done using microscope or endoscope. Present study is a comparison between these two techniques. Aims and Objectives: 1. Comparing the graft take-up rate between endoscopic and microscopic tympanoplasties. 2. Comparing the hearing result in microscopic and endoscopic tympanoplasties. 3. Comparing the operation time and postoperative complications. Materials and Methods: 100 patients were studied, out of which 50 were operated with microscope and 50 with endoscope. Patients were selected randomly from the ENT department. Results: Study shows that 50 patients were operated with endoscope and 50 were with microscope. The graft take-up rate is slightly higher in the endoscopic group in comparison to the microscopic group, i.e., 94% in the microscopic group and 96% in the endoscopic group. The endoscopic group has hearing improvement of average 17.4 dB as compared to the microscopic group (average 15.57 dB) postoperatively. A paired t-test shows P = 0.0001 (significant). Postoperative pain is more with the microscopic group. Clarity of vision is good with the endoscopic group. Conclusion: Hence, in our study, endoscopic tympanoplasty is better than microscopic tympanoplasty. But further study has to be done to identify the fact.

Quality of Life Assessment of Chronic Otitis Media Patients Following Surgery.

Chronic otitis media (COM) is a persistent inflammation of the middle ear. COM often requires surgical management and represents one of the most disabling pathologies in the field of otolaryngology, not only due to hearing loss but also because recurrent otorrhea seriously affects the quality of life (QoL) of patients. The COMOT-15 questionnaire is a reliable, valid and sensitive tool for measuring the QoL of patients with COM. The aim of this study was to evaluate QoL by using the Italian version of the COMOT-15 in COM patients undergoing surgery based on age and different operation techniques. This observational retrospective study involved fifty-two consecutive patients undergoing surgical treatment for COM according to Nadol criteria. Preoperatively (T0) and 12 months after surgery (T1) patients underwent clinical examination, imaging, the Italian version of the COMOT-15 and pure tone audiometry. After surgery, we observed an improvement of QoL in 84.6% of the population. The COMOT-15 overall score, ear symptoms and hearing subscores showed significantly better ratings after surgery in the whole analyzed group. However, the separate analysis of patients operated with open techniques and closed techniques showed a significant improvement in ear symptoms subscore in both groups and a significant improvement in hearing subscore and mental health subscore only in patients operated on with closed techniques. Moreover, we observed a positive correlation between age and Δ-COMOT. This study shows the crucial role of a reliable and suitable questionnaire such as the COMOT-15 in evaluating COM patients, including clinical symptoms, functional and psychological impairments and highlighting a positive correlation between age and COMOT-15 results.

Does drilling affect the hearing of contralateral normal ear after mastoid surgery?

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media (COM) is a recurrent infection of the middle ear and/or mastoid air cells affecting 2-3% of global population. Mastoidectomy is the mainstay of the treatment of COM. Bone drilling during mastoidectomy procedure exposes both the ears to acoustic trauma leading to sensorineural hearing loss. The present study was conducted to assess the possible deleterious effect of drilling on hearing of contralateral normal ear by monitoring pre-operative and post-operative pure tone audibility (PTA) and otoacoustic emissions (OAE). Aims and objectives were to evaluate the effect of drill- generated noise on hearing in non-operated ear during mastoidectomy in terms of hearing loss, its nature and duration and recovery of hearing loss.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; An observational study was carried out in ENT department at SMS medical college and hospital, Jaipur. Total 40 patients were studied. Pre-operative and post-operative PTA and OAE were studied and compared. Mean drilling time during mastoid surgery was also studied.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 40 subjects, maximum patients were 11-20 years of age group (37.5%) with female preponderance (57.5%). All had undergone mastiodectomy. Only 6 (15%) subjects had transient sensorineural hearing loss of contralateral normal ear as determined by comparing pre-operative and post-operative PTA and OAE. The mean recovery time was 2-3 days. The study had shown significant effect of drill generated noise on hearing of contralateral healthy ear following mastoidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions&lt;/strong&gt;: Drill-generated noise can’t be lowered to a great extent therefore drilling time should be minimized during mastoid surgeries.&lt;/p&gt;

Modified Radical Mastoidectomy: Open Mastoid Cavity versus Cavity Obliteration Using Periosteal Temporofascial Flap - A Comparative Study

Introduction The surgical treatment of Chronic Otitis Media by modified radical mastoidectomy usually results in an open cavity, with chronic discharge, hearing loss of 30 to 40 dB, frequent visits to OPD for debris removal and none the less dizziness on cold air exposure. One way to deal with these issues effectively is to obliterate the mastoid cavity. In our study we used vascularised periosteo-temporofascial swing flap with medicated bone dust to obliterate the mastoid cavity. Material and Methods In this prospective study, 50 patients who suffered from chronic otitis media, active squamous (cholesteatoma) disease, and underwent modified radical mastoidectomy with tympanoplasty procedure were and split between two equally sized groups. Group 1 had patients with open mastoid cavity and Group 2 had obliteration of mastoid cavity using vascularised periosteo-temporofascial swing flap with medicated bone dust. Patients were followed at 3rd week, 6th week, 3rd month and 6th month. Results Patients with cavity obliteration had better and statistically significant outcomes in term of discharge status of cavity and epithelization at 3 weeks. Patients with obliteration also had positive and statistically significant results in hearing levels and hearing gain at 6 months follow up. Conclusion Mastoid cavity obliteration with vascularised periosteo-temporofascial swing flap with medicated bone dust is a good and effective method for better post-operative outcomes and curtailing dependency on doctors for cavity care.

Quality of Life after Surgical Treatment for Chronic Otitis Media: A Systematic Review of the Literature.

This systematic review aims to (a) define what instruments are available to measure quality of life (QoL) in patients undergoing tympanoplasty for chronic otitis media (COM) and what is the most commonly selected timing to do so; (b) compare outcomes from different surgical techniques; and (c) describe any reported correlation between subjective and functional results. This review was conducted following the PRISMA statement recommendations. Of the 151 articles screened, 24 were included. Most studies had a prospective design. The mean age at surgery was 44.5 years. A microscopic retroauricular approach was the most common surgical technique. Most articles included both primary and revision surgeries. The most commonly used questionnaire was the Glasgow Benefit Inventory (GBI), followed by the Chronic Ear Survey (CES), the Chronic Otitis Media Outcome Test 15 (COMOT-15) and the Zurich Chronic Middle Ear Inventory (ZCMEI-21). Questionnaires were administered about 12 months after surgery in most studies. Ten studies reported possible associations between hearing results and QoL. QoL assessment after COM surgery variably relies on disease-specific and non-specific questionnaires. Patients are usually evaluated 12 months after surgery, and this appears to be a suitable timing to contrast the possible bias effect of different tympanoplasty techniques associated with different healing times. A comparison between QoL outcomes in different surgical approaches cannot be made, as several influencing factors have not been detailed in the included studies. Few studies have investigated the correlation between subjective and objective outcomes of tympanoplasty for COM so far.

Surgery for chronic otitis media in the elderly

PurposeTo evaluate the effectiveness and safety of surgery for chronic otitis media in elderly patients, compared to younger adults and children. MethodsPatients with chronic otitis media with and without cholesteatoma formation were assessed. Patients aged 65 years and older were included and compared to adults aged 35–55 and to children. Effectiveness was evaluated by comparing postoperative dry and safe ears in ages groups, safety was assessed by comparing postoperative adverse events. ResultsPostoperative success and adverse events did not differ between age groups. Children had more recurrent cholesteatoma than adults. No difference in recurrent cholesteatoma between adults was observed. ConclusionSurgical treatment for chronic otitis media with and without cholesteatoma in elderly patients is safe and effective. Age has no influence on postoperative adverse events and treatment outcomes in chronic otitis media. Cholesteatoma recurrence was not different between adult age groups.

A STUDY ON ROLE OF CORTICAL MASTOIDECTOMY IN CASES OF TYPE 1 TYMPANOPLASTY

Chronic otitis media (COM) is an inammatory process in the middle-ear space that results in long term, or permanent changes in the tympanic membrane including atelectasis, perforation, tympanosclerosis, retraction pocket development, or cholesteatoma [1]. COM is a major cause of acquired hearing impairment especially in developing countries.1 According to WHO, prevalence rate of COM in India accounts for 7.8% which is high.2 Perforation in tympanic membrane leads to hearing loss and recurrent ear infections. Persistent perforations occur either due to improper treatment of recurrent otitis media or infected traumatic perforation. Primary goal of treatment for COM (mucosal) is elimination of the chronic inammatory process. The secondary goal is reconstruction of sound conducting mechanism [10]. Tympanoplasty is a procedure to eradicate disease in the middle ear to reconstruct hearing mechanism with or without tympanic membrane grafting [2]. Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are signicant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing[3]. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is[4].

Antibiogram guided optimized medical treatment in chronic otitis media: A useful interventional strategy before surgery?

BackgroundChronic otitis media is a middle ear cleft disease presenting with tympanic membrane perforation and discharge. Wet ear after tympanoplasty and discharging mastoid cavity are problematic in clinical practice. Material and methods1050 patients of age 10 to 50 years presenting with active ear discharge and clinically diagnosed with unilateral chronic suppurative otitis media were included in the study. The patients were equally divided into two equal groups, Group ET, and AT. All patients were prescribed topical ciprofloxacin, oral levocetirizine 5 mg and n-acetyl cysteine 600 mg BD for one week. Swabs of ear discharge were collected in ET groups for antibiogram. Both groups were evaluated on next visit and treatment changed in AT groups and result observed in next visit. Surgical outcome was evaluated at end of 2 yrs. ResultA total of 1158 organisms were isolated in culture out of which, 69.94 % were aerobes, 13.47 % anaerobes and 16.58 % were fungi. On the second visit in group AT, treatment of 85.14 % patients was changed in accordance with culture sensitivity report. In patients with mucosal disease, only 46.87 % patients of group ET had a favorable outcome in comparison to 90.28 % patients of group AT while in patients with squamosal disease, 17.56 % patients of group ET and 28.99 % patients in group AT had a dry ear. Surgeries in AT group were found to have statistically significant higher success rate as compared to ET group.

Facial canal dehiscence, dural exposure, and labyrinthine fistula in middle ear cholesteatoma and mastoiditis.

To analyze the prevalence and associations of facial canal dehiscence (FCD), dural exposure, and labyrinthine fistula in chronic otitis media (COM) with and without cholesteatoma. This was a retrospective study performed in an academic medical center. Patients who received tympanoplasty with mastoidectomy for COM with and without cholesteatoma were included. The prevalence of FCD, dural exposure, and labyrinthine fistula in COM with and without cholesteatoma (mastoiditis) and their relationships were analyzed. A total of 189 patients, including 107 (56.6%) females and 82 (43.4%) males, with 191 ears were included. There were 149 cases (78.0%) of cholesteatoma and 42 patients (22.0%) with mastoiditis. FCD was noted in 27.5% of patients with cholesteatoma and 9.5% of patients with mastoiditis. Dural exposure was found in 21 patients (14.1%) with cholesteatoma and 4 patients (9.5%) with mastoiditis. Eleven patients (7.4%) with cholesteatoma and 1 patient (2.4%) with mastoiditis had labyrinthine fistula. Patients with a labyrinthine fistula had nearly a fivefold greater chance (OR = 4.924, 95% CI = 1.355-17.896, p = 0.015) of having FCD than those without a fistula. There was a positive correlation between dural exposure and labyrinthine fistula (P = 0.011, Fisher's exact test). FCD, dural exposure, and labyrinthine fistula are common complications in COM. These complications are more frequently observed in patients with cholesteatoma than in patients with mastoiditis. Surgeons should pay more attention to the treatment of COM.

Autoinflation compared to ventilation tubes for treating chronic otitis media with effusion

Background Otitis media with effusion (OME) is the most common cause of acquired hearing loss and surgery in children. Autoinflation has been suggested as an alternative treatment for OME. Objectives The aim of the study was to compare treatment outcome with a new autoinflation device versus ventilation tube (VT) surgery or watchful waiting in children with chronic bilateral OME from the waiting list for surgery. Methods Forty-five children performed autoinflation during four weeks, forty-five were submitted to VT surgery, and twenty-three were enrolled as control group. Tympanometry was performed in the autoinflation and the control groups and audiometry in all groups. Results An equivalent hearing improvement was achieved in the autoinflation and the VT group at one (p=.19), six (p=.23) and twelve (p=.31) months with no significant alteration in the control group. In the autoinflation group 80% of the children avoided surgery and no complications were reported compared to 34% complication rate in the VT group. Conclusion Autoinflation achieved an equivalent improvement in hearing thresholds compared to VT surgery for treating OME. Significance Autoinflation may be a reasonable first-line treatment for children with OME to potentially avoid surgery. Article Summary: The Moniri autoinflation device is well tolerated and an effective alternative to ventilation tubes for treatment of chronic otitis media with effusion in young children. What’s known on this subject: Previous studies have shown that autoinflation may reduce effusion in children with otitis media with effusion; however limited compliance to treatment, lack of adequate hearing evaluation, short follow-up time and also lack of comparative data to ventilation tube surgery have been reported. What this study adds: A new device was developed to allow for the performance of autoinflation in young children. The effect is compared to ventilation tube surgery and equivalent improvement in hearing is achieved in the short and the long-term follow-up.

Association between asthma or chronic obstructive pulmonary disease and chronic otitis media

We hypothesized that asthma/chronic obstructive pulmonary disease (COPD) might increase the risk of chronic otitis media (COM), as asthma or COPD affects other diseases. The aim of this research was to investigate whether the incidence of COM is affected by a diagnosis of asthma or COPD in patients compared to matched controls from the national health screening cohort. A COM group (n = 11,587) and a control group that was 1:4 matched for age, sex, income, and residence area (n = 46,348) were selected. The control group included participants who never received treatment for COM from Korean National Health Insurance Service-Health Screening Cohort from 2002 to 2015. The crude and adjusted odds ratios (ORs) of previous asthma/COPD before the index date for COM were analyzed using conditional logistic regression. The analyses were stratified by age, sex, income, and region of residence. The period prevalence of asthma (17.5% vs. 14.3%, p < 0.001) and COPD (6.6% vs. 5.0%, p < 0.001) were significantly higher in the COM group than in the control group. In addition, the odds of asthma and COPD were significantly higher in the COM group than in the control group. Both asthma (adjusted OR 1.23, 95% confidence interval [CI] 1.16–1.31, p < 0.001) and COPD (adjusted OR 1.23, 95% CI 1.13–1.35, p < 0.001) increased the ORs for COM. This positive association between asthma/COPD and COM indicates that asthma/COPD might increase the incidence of COM.

Development of Intracorporeal Differentiation of Stem Cells to Induce One-Step Mastoid Bone Reconstruction during Otitis Media Surgeries.

Mastoidectomy is a surgical procedure for the treatment of chronic otitis media. This study investigated the ability of rat stromal vascular fraction cells (rSVF) in combination with polycaprolactone (PCL) scaffolds and osteogenic differentiation-enhancing blood products to promote the regeneration of mastoid bone defect. Twenty male Sprague Dawley rats were randomly divided according to obliteration materials: (1) control, (2) PCL scaffold only, (3) rSVFs + PCL, (4) rSVFs + PCL + platelet-rich plasma, and (5) rSVFs + PCL + whole plasma (WP). At 7 months after transplantation, the rSVFs + PCL + WP group showed remarkable new bone formation in the mastoid. These results indicate that SVFs, PCL scaffolds, and blood products accelerate bone regeneration for mastoid reconstruction. Autologous SVF cells with PCL scaffolds and autologous blood products are promising composites for mastoid reconstruction which can be easily harvested after mastoidectomy. With this approach, the reconstruction of mastoid bone defects can be performed right after mastoidectomy as a one-step procedure which can offer efficiency in the clinical field.

Comparison of endoscopic and microscopic tympanoplasty in patients with chronic otitis media

BackgroundTo compare the results between type I tympanoplasty performed with transcanal endoscopic ear surgery (TEES) and microscopic ear surgery (MES) for treatment of chronic otitis media in a homogenous group of patients.MethodsA retrospective study was performed in our department between January 2011 and January 2016 to review primary type I tympanoplasty cases with a subtotal perforation, an intact ossicular chain, a dry ear for at least 1 month, normal middle ear mucosa, and a follow-up period of at least 6 months post surgery. The adoption of TEES or MES was divided temporally (before and since 2013). TEES was undertaken in 224 patients (224 ears) and MES in 121 patients (121 ears).ResultsThe successful graft take rate was 94.64% (212/224) in the TEES group and 90.91% (110/121) in the MES group (P = 0.239). The improvements in the air conduction levels between the 2 groups were not statistically different at 1, 3, or 6 (> 6) months (P > 0.05) after surgery. The improvements in the air–bone gaps were not significantly different between the 2 groups (P > 0.05). The average hearing gains in the TEES group 6 (and > 6) months post surgery were 11.85 ± 5.47 dB, which was better than 10.48 ± 5.18 dB in the MES group (P = 0.031). The use of medical resources was lower in the TEES group than in the MES group regarding the average operating time (49.22 ± 8.24 min vs 81.22 ± 14.73 min, respectively; P < 0.0001). Patients receiving MES had a significant higher incidence of the wound problems (ear pain, numbness around the ears, and wet ear; P < 0.05).ConclusionTEES for type I tympanoplasty seems to achieve a shorter operative time and ideal tympanic membrane healing rate and hearing results in patients with chronic otitis media.

Comparison of Reinforcement Cartilage Graft and Temporalis Fascia Graft in Type 1 Tympanoplasty

Background: Chronic otitis media (COM) is the long-standing infection of a part or whole of middle ear cleft characterized by ear discharge and perforation. It is the commonest ear problem in adult and children. Most common presenting symptoms are ear discharge, mild to severe hearing loss, sometimes tinnitus even vertigo. Treatment of COM is mainly operative. Inactive mucosal variety of COM presents with the perforation in tympanic membrane with non-inflamed middle ear mucosa. The treatment of inactive mucosal variety of COM is Type 1tympanoplasty. It can be done by conventional temporalis fascia or cartilage graft. Both have some merits and demerits. Objective: To compare the the outcomes between reinforcement cartilage graft and temporalis fascia graft in type -1 tympanoplasty. Methods: 86 (43 patients in each group) patients with COM (inactive mucosal) who were admitted in the department of Otolaryngology – Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2018 to June 2019, and had fulfilled the inclusion and exclusion criteria were selected for the study. History, examinations, investigations were done. All patients underwent type 1 tympanoplasty. Prior to surgery relevant investigations were done and informed written consent was taken from all patients. In Group-A reinforcement cartilage tympanoplasty cases and in Group-B temporalis fascia tympanoplasty cases were placed. Post-operative graft uptake rate and hearing gain were compared in two groups Results: The surgical outcomes between reinforcement cartilage tympanoplasty in comparison with temporalis fascia tympanoplasty showed no significant difference of graft uptake rate and hearing gain. Conclusion: Cartilage tympanoplasty has been practised for reconstruction of perforated tympanic membrane in COM since long with variable results. Graft uptake rate in cartilage reinforcement is comparatively better than temporalis fascia graft. So, reinforcement cartilage graft can be adopted as an alternative to temporalis fascia graft in type- I tympanoplasty. Bangladesh J Otorhinolaryngol 2021; 27(2): 104-110