Tympanoplasty Surgery Research Articles

Retrospective Study of Clinical Profile of Patients with Chronic Suppurative Otitis Media at a Tertiary Health Centre

Introduction: Chronic Suppurative Otitis Media (CSOM) is frequently associated with symptoms of inflammation like discharge from the ear or pain. In many cases, patients suffer from hearing loss causing communication problems and social withdrawal. Tubotympanic type of chronic suppurative otitis media is characterized by a perforation of pars tensa, while marginal & attic perforations are pathognomonic of attico–antral variety. The latter category is usually associated with the presence of cholesteatoma. In cases of cholesteatoma, complications like facial nerve paralysis, meningitis, cerebellar abscess, sigmoid sinus thrombosis may develop and potentially threaten the patient’s life. The aim of this study was to retrospectively perform analysis of patients suffering from Chronic Suppurative Otitis Media, visiting our Tertiary Health Centre, Nashik. Materials and Methods: This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 528 patients in and around Nashik District and were subjected to Tympanoplasty or Mastoid surgery. Results: Complete data records from 528 patients were available for statistical analysis. Maximum numbers of patients were in age group 21–40. High prevalence of CSOM was found in females. 408 patients had CSOM of Safe type. 97 patients had CSOM of unsafe type, whereas 23 patients had unsafe CSOM with complications. 381 patients underwent Type 1 Tympanoplasty, while 31 patients underwent Modified Radical Mastoid Surgery. 61 patients were operated for MRM with Tympanoplasty and 28 patients were operated for MRM with Myringostapediopexy. 27 patients were operated for revision tympanoplasty. Different methods of tympanoplasty were performed. Simple underlay was done in 123 patients. Maximum patients about 245 were operated by cartilage support method of tympanoplasty. Anterior tucking was done in 40 patients. Myringostapediopexy was done in 28 patients. Ossiculoplasty with tragal or conchal cartilage was done in 61 patients. Graft was not placed in 31 patients. Temporalis fascia was used in maximum patients. In 90.9% of patients temporalis fascia was used. Fascia Lata was used in 3.2% of patients. Conclusion: Retrospective study of patients with CSOM shows: females were affected more than males. Majority of patients were in age group of 21 to 40 years. The reason could be that this age group is socially active and health conscious. 77.3% of patients had safe CSOM while 22.7% of patients had unsafe CSOM. 2.27% of patients had extra–cranial complication, and 2.08% of patients had intracranial complications. 5.1% of patients underwent revision tympanoplasty surgery. Temporal is fascia as a graft material was used for tympanoplasty in maximum patients, and cartilage support method of tympanoplasty was used in majority of patients. Maximum patients were operated in year 2012. This was due to conduction of camps in peripheral areas around Nashik City which shows that CSOM is more common in patients of lower socioeconomic group, overcrowding, sub–standard hygiene and under resourced health care.

Retrospective Study of Clinical Profile of Patients with Chronic Suppurative Otitis Media at a Tertiary Health Centre

<strong>Introduction:</strong> Chronic Suppurative Otitis Media (CSOM) is frequently associated with symptoms of inflammation like discharge from the ear or pain. In many cases, patients suffer from hearing loss causing communication problems and social withdrawal. Tubotympanic type of chronic suppurative otitis media is characterized by a perforation of pars tensa, while marginal & attic perforations are pathognomonic of attico-antral variety. The latter category is usually associated with the presence of cholesteatoma. In cases of cholesteatoma, complications like facial nerve paralysis, meningitis, cerebellar abscess, sigmoid sinus thrombosis may develop and potentially threaten the patient's life. The aim of this study was to retrospectively perform analysis of patients suffering from Chronic Suppurative Otitis Media, visiting our Tertiary Health Centre, Nashik. <strong>Materials and Methods:</strong> This was a retrospective study, conducted in a tertiary care medical college hospital over a period of 5 years. The study group comprised 528 patients in and around Nashik District and were subjected to Tympanoplasty or Mastoid surgery. <strong>Results:</strong> Complete data records from 528 patients were available for statistical analysis. Maximum numbers of patients were in age group 21-40. High prevalence of CSOM was found in females. 408 patients had CSOM of Safe type. 97 patients had CSOM of unsafe type, whereas 23 patients had unsafe CSOM with complications. 381 patients underwent Type 1 Tympanoplasty, while 31 patients underwent Modified Radical Mastoid Surgery. 61 patients were operated for MRM with Tympanoplasty and 28 patients were operated for MRM with Myringostapediopexy. 27 patients were operated for revision tympanoplasty. Different methods of tympanoplasty were performed. Simple underlay was done in 123 patients. Maximum patients about 245 were operated by cartilage support method of tympanoplasty. Anterior tucking was done in 40 patients. Myringostapediopexy was done in 28 patients. Ossiculoplasty with tragal or conchal cartilage was done in 61 patients. Graft was not placed in 31 patients. Temporalis fascia was used in maximum patients. In 90.9% of patients temporalis fascia was used. Fascia Lata was used in 3.2% of patients. <strong>Conclusion:</strong> Retrospective study of patients with CSOM shows: females were affected more than males. Majority of patients were in age group of 21 to 40 years. The reason could be that this age group is socially active and health conscious. 77.3% of patients had safe CSOM while 22.7% of patients had unsafe CSOM. 2.27% of patients had extra-cranial complication, and 2.08% of patients had intracranial complications. 5.1% of patients underwent revision tympanoplasty surgery. Temporal is fascia as a graft material was used for tympanoplasty in maximum patients, and cartilage support method of tympanoplasty was used in majority of patients. Maximum patients were operated in year 2012. This was due to conduction of camps in peripheral areas around Nashik City which shows that CSOM is more common in patients of lower socioeconomic group, overcrowding, sub-standard hygiene and under resourced health care.

A short-term evaluation between the result of palisade cartilage tympanoplasty and temporalis fascia technique

Introduction: The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Study Design: Prospective study. Materials and Methods: The study population included 54 patients who were operated on in two groups (palisade technique and temporalis fascia technique) with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area), an intact ossicular chain, at least 1 month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre and postoperative audiograms were compared. The follow-up time was 6 months. Results: Graft acceptance was achieved in all patients (100%) in the palisade cartilage tympanoplasty group and in 25 patients (92.5%) in the temporalis fascia group. This difference was not statistically significant ( P = 0.15). Comparison of the increases in mean speech reception threshold, air-bone gap, and pure-tone average scores between both techniques showed no significant changes. Conclusion: Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.

Ototoxicity of Polymyxin B, Neomycin, and Hydrocortisone Suspension in Tympanoplasty Surgery

(1) To determine the safety of using a commercially available suspension of polymyxin B, neomycin, and hydrocortisone (PNH) in tympanoplasty surgery. (2) To apply evidence-based medicine to tympanoplasty surgery when considering potential ototoxicity. Case series with chart review. Tertiary otology practice, single surgeon. Approval for this study was obtained from the St. Dominic-Jackson Memorial Hospital Institutional Review Board. Data were gathered on 272 consecutive type 1, underlay tympanoplasties for which both pre- and postoperative audiometric data were available over a 10-year period. In each surgery, gelatin sponge saturated in a commercially available PNH suspension was placed in the middle ear to support the graft. Patients ranged in age from 3 years to 79 years. Preoperative and postoperative bone conduction thresholds were measured at 500, 1000, 2000, 3000, and 4000 Hz. The average change in sensorineural hearing as measured by bone conduction thresholds was negligible, with a slight improvement in all frequencies tested except 4000 Hz. The changes by frequencies were as follows: 500 Hz (-1.624 dB), 1000 Hz (-1.399 dB), 2000 Hz (-0.975 dB), 3000 Hz (-0.596 dB), and 4000 Hz (+0.560 dB). The 5-frequency average change was -0.545 dB. The commonly used otic solution containing polymyxin B, neomycin, and hydrocortisone demonstrates no ototoxicity in tympanoplasty surgery and is safe to use in this setting.

A new grafting technique for tympanoplasty: tympanoplasty with a boomerang-shaped chondroperichondrial graft (TwBSCPG)

The aim of this study was to introduce a new grafting technique in tympanoplasty that involves use of a boomerang-shaped chondroperichondrial graft (BSCPG). The anatomical and functional results were evaluated. A new tympanoplasty with boomerang-shaped chondroperichondrial graft (TwBSCPG) technique was used in 99 chronic otitis media patients with central or marginal perforation of the tympanic membrane and a normal middle ear mucosa. All 99 patients received chondroperichondrial cartilage grafts with a boomerang-shaped cartilage island left at the anterior and inferior parts. Postoperative follow-ups were conducted at months 1, 6, and 12. Preoperative and postoperative audiological examinations were performed and air-bone gaps were calculated according to the pure-tone averages (PTAs) of the patients. In the preoperative period, most (83.8%) air-bone gaps were ≥ 16 dB; after operating using the TwBSCPG technique, the air-bone gaps decreased to 0-10 dB in most patients (77.8%). In the TwBSCPG patients, the mean preoperative air-bone gap was 22.02 ± 6.74 dB SPL. Postoperatively, the mean postoperative air-bone gap was 8.70 ± 5.74 dB SPL. The TwBSCPG technique therefore decreased the postoperative air-bone gap compared to that preoperatively (p = 0.000, z = -8.645). At the 1-month follow-up, there were six graft perforations and one graft retraction. At the 6-month follow-up, there were nine graft perforations and three graft retractions. At 12 months, there were seven graft perforations and four graft retractions. During the first year after the boomerang tympanoplasty surgery, graft lateralization was not detected in any patient. Retractions were grade 1 according to the Sade classification and were localized to the postero-superior quadrant of the tympanic membrane. The TwBSCPG technique has benefits with respect to postoperative anatomical and audiological results. It prevents perforation of the tympanic membrane at the anterior quadrant and avoids graft lateralization due to placement of the graft under the manubrium mallei. Given these benefits, the TwBSCPG technique seems to be a good alternative for grafting in tympanoplasties.

A comparison of the effects of mastoidectomy and tympanoplasty on contralateral ear using otoacoustic emission in chronic otitis media surgery

In this study, we compared possible changes in the opposite ears of the patients who underwent mastoid surgery using a drill or tympanoplasty surgery without the use of a drill through distortion product otoacoustic emissions. Between November 2011 and March 2012, a total of 41 patients (17 mastoidectomy, 24 tympanoplasty) who were scheduled for surgery with the diagnosis of chronic otitis media without any pathology identified in their contralateral ears in our clinic were included. Distortion product otoacoustic emissions measurements were performed on their opposite ears of the patients for which no surgery was planned at the frequencies of 1, 1.4, 2, 2.8 and 4 kHz on pre- and postoperative day one and day seven. A statistically significant difference was found in the measurements taken on pre- and postoperative day seven at the frequency of 1.4 kHz in patients who underwent mastoidectomy. For the patients who underwent tympanoplasty, statistically significant differences were identified in the measurements on pre- and postoperative day one and postoperative day one-day seven at the frequency of 1 kHz; pre- and postoperative day one at 1.4 kHz; pre- and postoperative day seven and postoperative day one-day seven at 2 kHz and pre- and postoperative day one-day seven at 2.8 kHz. The comparison between mastoidectomy and tympanoplasty groups revealed a statistically significant difference in the rates of change on postoperative day one-day seven at the frequencies of 1, 1.4, 2.8 kHz and on pre- and postoperative day one at the frequency of 1.4 kHz. During the first and seventh days of surgery in both mastoidectomy with drilling and tympanoplasty surgery without drilling, statistically significant changes were observed in contralateral DPOAE amplitutudes.

Is the Bone-Conduction Headband Test Useful for Predicting the Functional Outcome of a Round Window Active Middle Ear Implant?

To estimate the reliability of the Bone Conduction-HeadBand (BC-HB) test for predicting the postoperative functional outcome of a round-window (RW) vibroplasty. Within-subject comparison of the functional results of the BC-HB test, which is routinely used for the preoperative evaluation of a bone-conduction transducer, with an active middle ear implant (AMEI) placed onto the round window. Tertiary referral university hospital center. Seven patients with similar anatomic (absent stapes superstructure) and functional (moderate, mixed hearing loss) sequelae from open tympanoplasty technique. All subjects underwent preoperative audiologic assessment with the BC-HB. Subsequently, all subjects underwent surgical placement of an AMEI onto the round window. Pure tone and speech audiometry in quiet and noise were assessed. Additionally, evaluation of specific satisfactory targets was performed using the Client Oriented Scale of Improvement. Pure tone and speech audiometry in quiet established that both devices had very similar performance and provided remarkable improvement compared with the unaided condition. However, high-frequency gain and speech audiometry in noise demonstrated better performance with RW-AMEI. In patients presenting with mixed hearing loss as a sequela from middle ear surgery, the preoperative BC-HB test may be helpful in predicting the final functional outcome and patient satisfaction with RW-AMEI.

Ototoxicity of Polymyxin B, Neomycin, and Hydrocortisone Suspension in Tympanoplasty Surgery

Objectives: 1) Determine the safety of using a commercially available suspension of polymycin B, neomycin, and hydrocortisone in tympanoplasty surgery.2) Apply evidence based medicine in tympanoplasty surgery when considering potential ototoxicity. Methods: Study Design: Retrospective chart review. Setting: Tertiary otology practice, single surgeon. Data were gathered on 277 consecutive type 1, underlay tympanoplasties for which both pre- and postoperative audiometric data were available over a 10 year period. In each surgery, gelatin sponge saturated in a commercially available suspension of polymycin B, neomycin, and hydrocortisone was placed in the middle ear to support the graft. Patients ranged from age 3y/o to 79y/o. Preoperative and postoperative bone conduction audiometric thresholds were measured at 500, 1000, 2000, 3000, and 4000Hz. Results: The average change in sensorineural hearing as measured by bone conduction thresholds was negligible, with a slight improvement in all frequencies tested except 4000Hz. The changes by frequencies were as follows: 500Hz (-1.624dB), 1000Hz (-1.399dB), 2000Hz (-0.975), 3000Hz (-0.596dB), and 4000Hz (+0.56dB). The five frequency average change was (-0.545dB). Conclusions: The commonly used otic solution containing polymycin B, neomycin, and hydrocortisone demonstrates no ototoxicity in tympanoplasty surgery and is safe to use in this setting.

A Study on Type-1 Tympanoplasty in Perforated Ear Drum

Tympanoplasty without mastoidectomy is performed to prevent recurrent infection and reconstruct the sound conducting mechanism. In our study 60 patients were selected for tympanoplasty operation. All operations were done in Dhaka National Medical college hospital and private hospital in Dhaka city. Choice of incision was post auricular approach. 20% of patients were operated under general anesthesia and 80% of patients were operated under local anesthesia. Age range of patient was between15 to 40 yrs. Female patients were predominant. Follow up of patients were up to 2yrs. Overall success rate was 93.3%. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16015 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 14-16

Functional and audiological results of tympanoplasty type I using pure perichondrial grafts

There are very few studies analyzing the functional und audiological results of tympanoplasty type I using pure perichondrium. Data of 80 randomly selected patients, who had tympanoplasty surgery between 1998 and 2008 with pure perichondrium were evaluated retrospectively. Average postoperative follow-up was 9 months. The preoperative- and postoperative status of tympanic membrane, air-bone gap (ABG) and influence of perforation size and perforation etiology on closure rate served as study parameters. The closure rate for tympanoplasty type I with pure perichondrium was 85% and the mean ABG reduction was 10.8±7.22 dB. Size and etiology of the perforation had no influence on operative results. Concerning closure rates pure perichondrium is very suitable for repairing tympanic membrane defects. Postoperative audiological results can be compared to other transplants, such as temporal fascia or combined cartilage-perichondrium grafts and the intraoperative handling and positioning seem to be more comfortable.

Timpanoplasti Cerrahisinde Desfluran ve Sevofluran Anestezisinin Kan Glukoz Düzeyleri Üzerine Etkilerinin Karşılaştırılması

Introduction: The effects of intravenous anesthetic drugs and inhaled anesthetics to the blood glucose (GLC) levels were investigated. Unfortunately, there is no adequate studies comparing these effects with new agents such as sevoflurane and desflurane drugs. In this study, blood GLC level changes among the the patients undergoing general anesthesia with sevoflurane and desflurane during the tympanoplasty surgery, were investigated. Material and methods: 60 patients,ages ranging between 18-65 in the ASA I-II risk group were randomly allocated to one of the two groups; The sevoflurane-remifentanyl drugs combination was applied to the group S and the desfluran-remifentanyl drugs combination was used for the group D. After fasting for 8 hours at the preoperative period, the blood GLC levels were measured before induction, at the 5 th , 10 th , 30 th , 60 th , 90 th , 120 th minutes, during the intraoperative period and 30 minutes after the extubation. Blood lactate levels were measured intraoperatively at 5th and 120th minutes.Results: There was no statistically significant difference between groups in terms of mean glucose levels (p>0,05). A statistically significant difference was observed between the T1-T6 and T0 values obtained in the desflurane groups according to the mean GLC level. In the sevoflurane group; there was no statistically significant difference at the third measurement time (p=0,223). In all other measurement times, the mean GLC levels were statistically significantly higher than the first measurement time.Conclusion: There was no difference between the two groups, in terms of blood GLC levels, representing patients who underwent anesthesia with sevoflurane and desflurane during tympanoplasty surgery.

A prospective randomized double-blind study comparing dexmedetomidine vs. combination of midazolam-fentanyl for tympanoplasty surgery under monitored anesthesia care

Background:Analgesia and sedation are usually required for the comfort of the patient and surgeon during tympanoplasty surgery done under local anesthesia. In this study, satisfaction scores and effectiveness of sedation and analgesia with dexmedetomidine were compared with a combination of midazolam-fentanyl.Materials and Methods:Ninety patients undergoing tympanoplasty under local anesthesia randomly received either IV dexmedetomidine 1 μg kg-1 over 10 min followed by 0.2 μg kg-1h-1 infusion (Group D) or IV midazolam 0.06 mg kg-1 plus IV fentanyl 1 μg kg-1 over 10 min (Group MF) followed by normal saline infusion at 0.2 ml kg-1h-1. Sedation was titrated to Ramsay sedation score (RSS) of three. Vital parameters, rescue analgesics (fentanyl 1 μg kg-1) and sedatives (midazolam 0.01 mg kg-1), patient and surgeon satisfaction scores were recorded.Results:Patient and surgeon satisfaction score was better in Group D than Group MF (median interquartile range (IQR) 9 (8-10) vs. 8 (6.5-9.5) and 9 (8.5-9.5) vs. 8 (6.75-9.25), P = 0.0001 for both). Intraoperative heart rate and mean arterial pressure in Group D were lower than the baseline values and the corresponding values in Group MF (P < 0.05). Percentage of patients requiring rescue fentanyl was higher in Group MF than Group D (40% vs. 11.1%, P = 0.01). One patient in Group D while four in Group MF (8.8%) required rescue sedation with midazolam (P > 0.17). Seven patients in Group D had dry mouth vs. none in Group MF (P = 0.006). One patient in Group D had bradycardia with hypotension which was effectively treated.Conclusion:Dexmedetomidine is comparable to midazolam-fentanyl for sedation and analgesia in tympanoplasty with better surgeon and patient satisfaction. Hemodynamics need to be closely monitored.

Clinical Study of Influence of Prognostic Factors on the Outcome of Tympanoplasty Surgery

Asbtract: Myringoplasty is the operation specifically designed to close tympanic membrane defects the main aim of surgery of chronic ear disease is to eliminate disease process and reconstruct middle ear to give the patient a dry safe and functioning ear. In this study a clinical study of myringoplasty underlay technique in the management of central perforations done. Main emphasis is laid on evaluation of prognostic factors like Eustachian tube function, middle ear mucosa at operation and audiometric evaluation pre and post operatively. A series of patients treated in the Department of ENT, Government General Hospital, Kurnool during the period of two years is taken for the study. Relevant literature regarding anatomy, physiology, pathophysiology, clinical features and various methods of medical and surgical management are reviewed.

Canal wall dow mastoidektomi ile birlikte tip III timpanoplasti ameliyatı geçiren hastalarda işitme sonuçları

Objective: Preoperative and postoperative hearing results were compared in patients undergoing hearing reconstruction through open mastoidectomy with type III tympanoplasty method in our center. Methods: A total of 46 patients with chronic suppurative otitis media, who had undergone ossicular chain reconstruction by type III tympanoplasty with canal wall down mastoidectomy (CWDM) operation between January 2005 and 2009 were enrolled in the trial. The preoperative status of ossicular chain, the reconstruction methods on the ossicles, as well as the materials used in the reconstruction and the presence of stapes superstructure were recorded. Postoperative hearing gain of patients was evaluated by pure tone audiometry on an average of 6th months following surgery. Results: Among enrolled patients, 18 were females (39%) and 28 were males (61%). In 30 patients (65%), cholesteatoma was seen to have extended to the attic, antrum, supratubal recess and sinus tympani, while in 16 cases, cholesteatoma was determined to have partly invaded the mastoid cavity and mesotympanum. A polypoid tissue, arising from mucosa of middle ear and sagging into the external ear canal was detected in 6 patients (13%). While the preoperative and postoperative mean air-bone gaps were determined as 33.96 dB and 28.21dB, respectively. Preoperative and postoperative audiological examinations revealed an air-bone gap of £25 dB in 26.1 and 47.8% of the cases respectively. Conclusion: Type III tympanoplasty operation with canal wall down mastoidectomy provides eradication of the disease with cholesteatoma and enables reconstruction of hearing.

The Role of Diffusion-Weighted Magnetic Resonance Imaging in Cholesteatoma Diagnosis and Follow-up: Study With the Diffusion PROPELLER Technique

Introduction and objectivesThe diagnosis of cholesteatoma is based on clinical evaluation and computed tomography. New non-echo-planar diffusion-weighted magnetic resonance imaging (MRI) techniques, without intravenous contrast, are capable of differentiating cholesteatoma from inflammatory tissue, cholesterol granuloma and granulation tissues. The technique is very helpful in differential diagnosis of cholesteatoma, mainly after canal wall-up tympanoplasty surgery, to avoid routine second-look surgery in these patients. Congenital cholesteatoma and difficult cases can be detected and correctly diagnosed as well. The aim of this study was to evaluate sensitivity, specificity, positive predictive value and negative predictive value of the diffusion-weighted PROPELLER MRI in cholesteatoma diagnosis. MethodsA prospective study was performed on 52 patients. Clinical and surgical findings were correlated with diffusion-weighted PROPELLER MRI results. ResultsSensitivity, specificity and positive and negative predictive values were 92.85%, 92.30%, 92.85% and 92.30%, respectively. ConclusionsDiffusion-weighted PROPELLER imaging is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2mm.

Papel de la resonancia magnética de difusión en el diagnóstico y seguimiento del colesteatoma. Estudio con la técnica PROPELLER difusión

Introduction and objectivesThe diagnosis of cholesteatoma is based on clinical evaluation and computed tomography. New non-echo-planar diffusion-weighted magnetic resonance imaging (MRI) techniques, without intravenous contrast, are capable of differentiating cholesteatoma from inflammatory tissue, cholesterol granuloma and granulation tissues. The technique is very helpful in differential diagnosis of cholesteatoma, mainly after canal wall-up tympanoplasty surgery, to avoid routine second-look surgery in these patients. Congenital cholesteatoma and difficult cases can be detected and correctly diagnosed as well. The aim of this study was to evaluate sensitivity, specificity, positive predictive value and negative predictive value of the diffusion-weighted PROPELLER MRI in cholesteatoma diagnosis. MethodsA prospective study was performed on 52 patients. Clinical and surgical findings were correlated with diffusion-weighted PROPELLER MRI results. ResultsSensitivity, specificity and positive and negative predictive values were 92.85%, 92.30, 92.85 and 92.30%, respectively. ConclusionsDiffusion-weighted PROPELLER imaging is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2mm.

Allergic fungal otomastoiditis: A case report

Allergic mucin is described as thick, peanut butter-like mucus impacted in the paranasal sinuses of patients with allergic fungal rhinosinusitis. The presence of allergic mucin in the middle ear has never been reported. We encountered a 65-year-old female with allergic mucin found impacted in her left middle ear and mastoid cavity during revised tympanoplasty surgery at our institute. Bilateral endoscopic sinus surgery performed 3 months later showed no evidence of fungal infection or allergic mucin in her paranasal sinuses. We report the case herein and propose the term allergic fungal otomastoiditis for this disease entity.

Tympanoplastyka typu otwartego – wskazania, technika operacyjna

Summary Open tympanoplasty is the standard procedure in otology which is well defined and widely spread among otorhinolaryngologists. It is preferable techniques in very advanced cases and in reoperations due to cholesteatoma recidive. The principle of this operation is to remove completely the superior and posterior part of the external osseous auditory canal and creation so called modified radical cavity (not Bondy modified radical mastoidectomy). As the consequence of this wide opening, the obligatory last step of this operation is enlargement of the skin entry to the external auditory canal. Open tympanoplasty can be effective technique especially in cholesteatoma

Tympanoplasty with Island Cartilage or Temporalis Fascia: A Comparative Study

Purpose: To compare clinical and audiological outcomes of the type 1 tympanoplasties where conchal cartilage (island graft) and temporalis fascia were used as the graft material. Procedures: In this retrospective study, the results of type 1 tympanoplasty operations (n = 50) in which cartilage and temporalis fascia were used for graft material were compared. Results: Pre- and postoperative otoscopic findings of both groups were similar (p > 0.05). Preoperatively, the pure tone averages (PTAs) and hearing thresholds of the fascia and cartilage groups were similar (p > 0.05). However, postoperatively, the PTAs and air-bone gap closure were better with temporalis fascia compared to cartilage grafting (p < 0.05). On frequency-specific comparisons, the pure tone thresholds at the frequencies of 0.5, 1 and 2 kHz recovered better with temporalis fascia compared to cartilage (p < 0.05). Although the pure tone recovery was better at 4 kHz with temporalis fascia, the difference between the groups were not significantly different (p > 0.05). Conclusion and Message: In conclusion, in contrast to many reports in the literature, temporalis fascia grafting seems better in our study than grafting with conchal cartilage.

A Short-term Comparison Between Result of Palisade Cartilage Tympanoplasty and Temporalis Fascia Technique.

The use of cartilage as a grafting material has been advocated in cases where there is a high risk of graft failure, such as subtotal perforations, adhesive processes, and residual defects after primary tympanoplasties. The purpose of this study was to compare the graft acceptance rates and auditory outcomes of cartilage tympanoplasty operations using a palisade technique with those of primary tympanoplasty using temporalis fascia in a homogenous group of patients. Prospective study. The study population included 54 patients who were operated on in two groups (palisade technique & temporalis fascia technique) with each group containing 27 patients. Patients with pure subtotal perforations (perforation of >50% of the whole tympanic membrane [TM] area), an intact ossicular chain, at least a one month dry period, and normal middle ear mucosa were included in the study. Grafts acceptance rates and pre- and post-operative audiograms were compared. The follow-up time was six months. Graft acceptance was achieved in all patients (100%) in the palisade cartilage tympanoplasty group and in 25 patients (92.5%) in the temporalis fascia group. This difference was not statistically significant (P= 0.15). Comparison of the increases in mean speech reception threshold, air-bone gap, and pure-tone average scores between both techniques showed no significant changes. Our experience with the palisade cartilage technique demonstrates that subtotal or total perforation at high risk for graft failure can be treated efficiently, and that a durable and resistant reconstruction of the TM with reasonable auditory function can be achieved.