Tympanoplasty Procedures Research Articles

Tympanoplasty in Northern Ethiopia: success rates, failure factors, and audiometric improvements

ObjectiveThis study aimed to determine the success rate of tympanoplasty, the factors associated with failure rate, and audiometric gains after the surgical procedure in Ethiopia.ResultsThere were 82 successful grafts take out of the 92 tympanoplasty procedures with an overall success rate of 89.1%. Females, who had tympanoplasty had 45 (91.8%) successful grafts while 37 (86.0%) successful grafts for male. Of the total tympanoplasties, 50(53.4%) of it were done in the left ear. Ear discharge was found to be a significant predictor of tympanoplasty failure rate [AOR = 9.6, 95% CI (1.1 − 88.8)]. There was a significant gain of air conduction with a p-value of < 0.001 after the tympanoplasty procedure which was about 13 dB mean difference.ConclusionsIn this study, only post-operative ear infection was found to decrease the success rate of tympanoplasty significantly. It also revealed that tympanoplasty improves hearing ability. We recommend a strict application of infection prevention and control strategies, and adequate and comprehensive follow-up of patients including audiometric assessment.

Outcomes of Type-1 Tympanoplasty with and without use of Topical Nasal Steroids; a Comparative Study

Objective: To compare the outcome of Type-1 tympanoplasty procedure in patients given intranasal steroids post-operatively versus those not given intranasal steroids after procedure. Study Design: Quasi-Experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi. Pakistan from May 2021 to May 2023. Methodology: A total of 464 patients, 232 of which were given intranasal steroids (Group-A), and 232 who were not given intranasal steroids (Group-B) were made part of this research. Upon inclusion, all pre-operative demographics were documented. Patients in post-operative follow up period were assessed for condition of tympanic membrane and improvement of hearing ability. Results: In current study, post-operatively, in patients who were given intranasal steroids, graft take-up frequency was 227(97.84%) and residual perforation was 5(2.16%) was better than in patients who were not given intranasal steroids, which came to 224(96.55%) and 8(3.45%), respectively (p=0.399). In terms of post-operative WHO grade of hearing impairment distribution (p&lt;0.001) and post-op hearing status (p=0.005) difference between patients who were given intranasal steroids and those not given intranasal steroids was statistically significant. Conclusion: Addition of intranasal steroid spray to the treatment regimen following tympanoplasty is provides better outcomes in terms of higher graft take-up frequency and an improvement in hearing from preoperative levels.

Comparative Study of Endoscopic Transcanal Tympanoplasty and Tympanoplasty by Conventional Postaural Approach in a Tertiary Care Hospital in Central India.

Background Chronic otitis media (COM) often necessitates tympanoplasty to repair the tympanic membrane. While conventional postaural tympanoplasty (PA) is well-established, endoscopic transcanal tympanoplasty (ET) is gaining traction for its minimally invasive benefits. This study aims to compare these two surgical techniques regarding their anatomical and functional outcomes and assess the role of platelet-rich plasma (PRP) in improving these outcomes. Material and methods This prospective comparative study was conducted at Acharya Vinoba Bhave Rural Hospital, involving 60 patients with COM. Participants were randomly assigned to receive either ET or PA, with each group further subdivided based on PRP use. Preoperative evaluations included auditory function tests and diagnostic endoscopy. Postoperative assessments were performed at seven days, one month, and three months to evaluate graft acceptance and hearing improvement using pure tone audiometry (PTA). Statistical analyses included the chi-square test, t-test, ANOVA, and paired t-test. Results The study included patients with a mean age of 38.1 years, predominantly female (71.67%). ET demonstrated superior anatomical outcomes compared to PA, with higher graft acceptance rates and better hearing improvements. The average hearing gain was 10.4 dB in the ET group versus 8.1 dB in the PA group. PRP uses enhanced graft acceptance and hearing restoration across both surgical approaches, contributing to better overall outcomes. Conclusion ET offers significant advantages over conventional postaural tympanoplasty in terms of anatomical and functional results. PRP further improves surgical outcomes, making ET a preferable option for tympanoplasty in COM patients. These findings support the broader adoption of ET and PRP to enhance patient outcomes in tympanoplasty procedures.

The Impact of Topical Application of Platelet-Rich Fibrin on Graft Survival in Surgeries for Chronic Otitis Media.

This study aims to evaluate the efficacy of platelet-rich fibrin (PRF) application in tympanoplasty procedures for patients with chronic otitis media (COM), assessing its influence on graft survival and healing time. In this prospective interventional study, conducted between January 2022 and June 2023, 80 patients diagnosed with COM were enrolled and divided into two groups. Group A underwent standard tympanic membrane repair using temporal fascia grafts (TFG), while Group B received TFG with adjunctive PRF application. The patients were observed and assessed over a 20-week postoperative period. The study showed a significant enhancement in graft survival rates in Group B (TFG+PRF), with only one residual perforation compared to seven in Group A (TFG alone) at 20 weeks (p=0.02534). Furthermore, Group B patients experienced faster healing, achieving 97.5% graft integrity at 10 and 20 weeks, in contrast to Group A's 87.5%. The application of PRF in tympanoplasty procedures for COM notably enhances graft stability and expedites the healing process. These findings suggest that PRF can be a valuable adjunct in otolaryngological surgeries, offering potential improvements in patient outcomes and surgical efficacy.

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

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

Hybrid Retroauricular Approach Without Ear Canal Skin Incision

The majority of tympanoplasty procedures have been performed using the retroauricular approach to improve visualisation of the anterior tympanic membrane. The classic retroauricular approach requires elevation of the Körner flap and tympano-meatal flap through the ear canal skin incision. This step can lead to the exposure of the bones in the ear canal, resulting in delayed wound healing and pain, especially in elderly or immunocompromised patients. Endoscopic ear surgery is a minimally invasive procedure that offers a wider field of view, but has the disadvantage of being a one-handed operation and cannot avoid skin incisions in the ear canal for tympanoplasty. Here we present a hybrid retroauricular approach without skin incision of the ear canal, using both microscope and endoscope. This method provides very fast wound healing and significantly less pain.

Monitored Anesthesia Care in Tympanoplasty a Comparative Study of Pentazocine Phenargan Combination versus Pentazocine Dexmedetomidine

The objective of this study was to compare the effectiveness and safety of two different drug combinations used for monitored anesthesia care (MAC) in tympanoplasty procedures. The first combination consisted of pentazocine and phenergan, while the second combination included pentazocine and dexmedetomidine. A prospective, randomized controlled trial was conducted on patients scheduled for tympanoplasty surgery. A total of 100 patients were randomly assigned to either the pentazocine-phenergan group or the pentazocine-dexmedetomidine group. The primary outcome measured included the level of sedation achieved, pain scores during surgery, and the incidence of adverse events such as respiratory depression, nausea, vomiting, bradycardia and hypotention. The results showed that the pentazocine-dexmedetomidine combination achieved a higher sedation score and lower pain scores compared to the pentazocine-phenergan combination. Sedation score in Group PP mean RSS of 1.928571429, while Group PD had a higher mean RSS score of 3.142857143 also VAS scores in Group PP mean VAS sore of 4.542857143, and Group PD had mean VAS score of 3.285714286. However, higher incidences of adverse events were noted in Group PD compared with Group PP. In conclusion, this comparative study suggests that the pentazocine-dexmedetomidine combination may offer superior sedative effects and better analgesia compared to the pentazocine-phenergan combination during tympanoplasty with manageable adverse effects.

Postoperative Outcomes After Tympanoplasty for Active Versus Inactive Otitis Media Patients With Tympanic Membrane Perforation: A Systematic Review and Meta-Analysis.

To compare postoperative tympanoplasty outcomes between active versus inactive otitis media (OM) patients with tympanic membrane perforation. Medline via PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar for studies published from inception to March 1, 2023. Studies of 15- to 60-year-old patients undergoing microscopic/endoscopic myringoplasty using underlay/overlay technique with reported postoperative mean hearing gain and graft uptake were included. Studies requiring simultaneous surgical procedures, reporting patients with comorbidities and with non-English full text articles were excluded. Articles were independently screened by two researchers with data extracted according to a predetermined proforma in Microsoft Excel. Cochrane risk-of-bias assessment was used for risk of bias evaluation of randomized studies and Risk of Bias in Nonrandomized Studies of Interventions for nonrandomized studies. Similar studies were pooled for meta-analysis using the inverse variance random effects model to calculate the mean difference and corresponding 95% confidence interval (CI) for mean hearing gain and DerSimonian and Laird random effects model for graft uptake. Thirty-three studies comprising 2,373 patients met the inclusion/exclusion criteria, seven were pooled for meta-analysis. Included articles showed inactive OM patients have higher average postoperative mean hearing gain of 10.84 dB and graft uptake of 88.7% compared to active OM patients (9.15 dB and 84.2%). Meta-analysis of mean hearing gain (MD, -0.76 dB; 95% CI, -2.11 to 0.60; p = 0.27, moderate certainty) and graft uptake (OD, 0.61; 95% CI, 0.34-1.09; p = 0.10, moderate certainty) have an overall p value >0.05. There were no statistically significant differences in postoperative mean hearing gain and graft uptake between active and inactive OM patients undergoing tympanoplasty. Hence, tympanoplasty procedures should not be postponed solely because of patients' preoperative ear discharge status.

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

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

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.

Racial Disparities in Tympanoplasty Surgery: A 30-Day Morbidity and Mortality National Cohort Study.

To assess the impact of race and ethnicity on 30-day complications after tympanoplasty surgery. The National Surgical Quality Improvement Program database was queried for tympanoplasty procedures from 2005 to 2019. Demographic, comorbidity, and postoperative complication data were compared according to race using univariate and binary logistic regression analyses. A total of 11,701 patients were included, consisting of 80.3% White, 3.0% Black, 7.7% Asian, 5.7% Hispanic, 2.5% American Indian/Alaska Native, and 0.8% other. Binary logistic regression model indicated that Black patients had increased odds of unplanned readmittance (p = 0.033; odds ratio [OR], 3.110) and deep surgical site infections (p = 0.008; OR, 6.292). American Indian/Alaska Native patients had increased odds of reoperation (p = 0.022; OR, 6.343), superficial surgical site infections (p < 0.001; OR, 5.503), urinary tract infections (p < 0.001; OR, 18.559), surgical complications (p < 0.001; OR, 3.820), medical complications (p = 0.001; OR, 10.126), and overall complications (p < 0.001; OR, 4.545). Although Black and American Indian/Alaskan Native patients were more likely to have complications after tympanoplasty surgery after adjusting for comorbidities, age, and sex, these results are tempered by an overall low rate of complications. Future studies should be devoted to understanding the drivers of these health inequities in access to otologic care and surgical treatment to improve outcomes and achieve equitable care.

A Review of the Middle Ear Risk Index as a Prognostic Tool for Outcome in Middle Ear Surgery.

This review article aims to scrutinize the studies conducted to determine a relationship between preoperative Middle Ear Risk Index (MERI) factors and postoperative graft acceptance and audiological gain in patients undergoing tympanoplasty procedures in middle ear surgeries. Critical analysis is done on numerous research and types of studies that were done in this area during the past years. The clinical and technical aspects connected to disease and its care have a variety of effects on the morphological and functional outcome of tympanoplasty. A better comprehension of these characteristics aids in better disease prognostication, surgical planning, and patient counseling. At the end of this review, we can conclude that the MERI score is inversely proportional to the post-operative graft acceptanceand audiological gain. The accumulated MERI is hence a good prognostic factor for the hearing outcome ofsurgery.

Microscopic Over-under Versus Medial Tympanoplasty for Larger Tympanic Membrane Perforations.

To identify the differences in hearing, anatomical success rate, functional success rate, and complications between over-under tympanoplasty and medial tympanoplasty procedures. The clinical data of patients with tympanic membrane perforation repaired by medial tympanoplasty between January 2011 and December 2016 and by over-under tympanoplasty between January 2017 and December 2020 were retrospectively analyzed. We evaluated the differences between medial tympanoplasty and over-under tympanoplasty. The overall success rate of over-under tympanoplasty was higher than that of medial tympanoplasty (90.76% vs 81.31%). In large perforations, the success rate of over-under tympanoplasty was higher than that of medial tympanoplasty (89.80% vs 71.43%). There was no statistically significant difference in the success rate between the two treatment groups for moderate perforations. Furthermore, there was no statistically significant difference in the incidence of complications between the two groups (P = .2637). Over-under tympanoplasty is more suitable for large perforations of the tympanic membrane and has a higher success rate as compared to medial tympanoplasty.

Evaluating the Role of Middle Ear Risk Indices in Assessing Postoperative Outcome following Tympanoplasty Procedure

Introduction Tympanoplasty is the treatment of choice for patients suffering with Chronic Otitis Media (COM). Outcome of tympanoplasty depends on various factors like size and location of tympanic membrane perforation, ear ossicles, degree of otorrhea, cholesteatoma, smoking history, granulation tissue etc. Prediction of outcome of tympanoplasty procedure prior to surgery with respect to graft uptake and hearing improvement can serve as a crucial factor in decision making in resource limited nations. Hence, a study was conducted to evaluate the role of Middle Ear Risk Indices (MERI) in predicting the outcome among patients undergoing tympanoplasty procedure. Materials and Methods A prospective study at a tertiary care centre was conducted for a duration of 2 years among 60 patients with COM who underwent tympanoplasty. Results The mean age of patients was 25.32 ± 8.43 years with a male to female ratio of 3:2. Majority (78.46%) of the patients had Mild MERI score; 18.46% patients had moderate MERI score and 3.08% patients had severe MERI risk score. The difference in mean Air –Bone (AB) gap in the mild and moderate MERI groups’ pre and post operatively was found to be statistically highly significant (p&lt;0.001). Conclusion Lower MERI scores prior to surgery showed significantly better outcomes with respect to graft uptake, degree of AB gap closure and hearing improvement.

Time Flow Study to Assess Opportunities to Improve Efficiency in Endoscopic Tympanoplasty.

BACKGROUNDTo characterize the workflow during transcanal totally endoscopic tympanoplasty by recording the time and instrumentation used for different steps in the procedure. This analysis aims to identify aspects of instrumentation and surgical technique that could be modified to improve surgical efficiency.METHODSThirty-one endoscopic tympanoplasty procedures were observed at a single academic center. Patient age ranged from 2.7 to 17.8 years. The procedure was separated into distinct steps. The duration in minutes and the instruments used were recorded by an independent observer.RESULTSRaising the tympanomeatal flap (median 9.82 minutes) and positioning the graft and replacing the flap (median 9.13 minutes) took significantly longer than all other steps (P > .05, Wilcoxon method). Teaching a trainee significantly increased step duration by a total of 32.8 minutes (P > .05, Wilcoxon method). There was no correlation between age of the patient, side of the ear, surgical technique, or graft type, and duration of surgery. Suction instruments with a functional tip (dissector or knife tip) were most commonly used to dissect and maneuver soft tissue while maintaining the surgical field clear of blood.CONCLUSIONAs elevation of the tympanomeatal flap and graft placement are the most time-consuming steps in endoscopic tympanoplasty, especially for surgical trainees, surgical efficiency could most dramatically be enhanced by modification of instrumentation or technique to facilitate these steps. Modification of simpler steps such as hair trimming and ear canal packing have less potential for shortening surgical duration.

Canalplasty in Tympanoplasty – Functional and Surgical Outcome

Background: During repair of central perforations of tympanic membrane, annulus should be visible in a single view. It helps in better placement of graft. To attain this, the bony canal is enlarged. Materials and Methods: Eighty patients with dry central perforation were selected during the period 2010–2020. Sixty patients with dry central perforation underwent tympanoplasty Type 1 with canalplasty and twenty patients were subjected to tympanoplasty Type 1 only. The method, operative procedure, and words of wisdom to give good results and prevent complications are described. Results: Patients with canalplasty had better postoperative results, and the success rate is improved as compared to only myringoplasty. The primary outcome measure of canalplasty with tympanoplasty procedure is complete re-epithelization and provision of a dry ear in 95%, whereas the final outcome without canalplasty was 90%. Conclusion: The aim of the canalplasty is to create a wide, patent, and physiological bony ear canal. Canalplasty helps to have better visualization, better postoperative care, better exposure for ossiculoplasty, time gain during graft placement, prevent lateralization, and promotes healing. It does improve the surgical outcome in tympanoplasty Type I.

The MO-meatocanalplasty: long-term results in the narrow external auditory canal with recurrent otitis externa or the inability to wear a hearing aid.

The MO-meatocanalplasty is the oblique modification of the M-meatoplasty. The MO-meatocanalplasty was designed to address the superior quadrants of the meatus and the bony canal without the need for a retro-auricular incision. This retrospective analysis was performed to evaluate the long-term results of the MO-meatocanalplasty in patients with a narrow external auditory canal (EAC) with recurrent otitis externa or in patients unable to wear a hearing aid. Twenty-two ears in twenty consecutive patients who received a MO-meatocanalplasty for a narrow EAC with recurrent otitis externa or the inability to wear a hearing aid were analysed retrospectively. There were no patients included with any type of previous or planned second stage tympanoplasty procedures. A follow-up period of 3years was analysed for postoperative recurrent narrowing, the self-cleaning capacity of the EAC, the recurrence of otitis externa, the inability to wear a hearing aid, change in hearing level and for all types of aesthetical complaints. The MO-meatocanalplasty procedure was effective in 82% (n = 18). Postoperative recurrent narrowing was detected in 9% (n = 2). Insufficient self-cleaning capacity of the EAC was 9.1% (n = 2). The ability to wear a hearing aid was restored in all patients with the need for a hearing aid. No aesthetical complaints were reported. The MO-meatocanalplasty is an effective, safe and aesthetical accepted procedure to address the narrow meatus and external auditory canal. With this procedure, there is no need for a retro-auricular incision in order to create a well aerated, dry and self-cleaning EAC in patients with a narrow EAC with recurrent otitis externa or in patient with the inability to wear a hearing aid.

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting.

This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3-71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4-9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

A comparative study on outcome of Type I Tympanoplasty using sliced 1-mm Conchal cartilage and full-thickness Conchal cartilage for grafting

BackgroundThis study aims at comparing the pure tone audiogram and tympanogram results of a measured thickness (1 mm) conchal cartilage graft material (1.0-mm CC) with full-thickness conchal cartilage (FTCC) used for inactive chronic suppurative otitis media (CSOM) mucosal disease with moderate size perforation.ResultsA total of 40 successful cartilage tympanoplasty procedures were included in the prospective quasi-randomised study. Patients aged between 15 and 55 years with inactive CSOM—moderate size perforation in the tympanic membrane were included. The patients were assessed at the end of 12 weeks with a pure tone audiogram and a tympanogram. The results were compared to know the compliance of the tympanic membrane (TM) between the two groups and the difference in audiometric gain (air-bone gap closure). The air-bone gap gain was better in the 1.0-mm CC group of patients (12) compared to the FTCC group of patients (7). The difference was statistically significant (p = 0.04). The 1.0-mm CC group of patients showed better compliance (0.43) compared to FTCC group of patients (0.73). The air volume and compliance were significantly better in the 1-mm CC group compared to the FTCC group (p = 0.031 and 0.01 respectively).ConclusionThe use of sliced cartilage seems to have a better role in reconstructing the TM when compared to full-thickness cartilage as graft material. It is indeed beneficial to have a compliant TM. Though the results cannot be compared with temporalis fascia grafts, the use of 1.0-mm CC has its advantage in producing an audio logically acceptable outcome in tympanoplasty surgery.

Evaluation of graft taking and hearing threshold after tympanoplasty

Background: Tympanoplasty is one of the surgical procedures mainly aimed to restoring the hearing loss and eradication of chronic middle ear diseases. Aim: To evaluate the hearing threshold preoperatively and postoperatively in patients who were subjected to tympanoplasty procedures. Patients and methods: This prospective study included 27 patients attended ENT department of AL-Yarmouk Teaching Hospital ,from February -2017 to October- 2018 , The age of patients between (10-60 years) of both gender . they presented with hearing loss as a result of chronic suppurative otitis media. After full assessment and proper preparation , They underwent Tympanoplasty procedure through post auricular incision using underlay temporalis fascia graft , The type of Tympanoplasty procedure was planned according to the status of the middle ear and ossicular chain .To eradicate disease from both the mastoid and middle ear cavity procedure and could be combined with mastoidectomy, Patients were evaluated preoperatively and followed up for 6 months postoperatively, pure Tone Audiogram was done to asses the change in hearing. Results: The study included 27 patients, (74.06%) of them were the age group between (21–40) years , the least number of patients were younger than 21 years and older than 51 years , 16 females (59.3%) and 11 males (40.7%) , Patients were classified according to tympanoplasty procedures into five groups : (Group1):10 patients (37.03%) underwent only Type I tympanoplasty. (Group2): 11 patients (40.7%) Type I with Cortical Mastoidectomy. (Group3): 2 patients (7.4%) Type II with Cortical Mastoidectomy. (Group4): 3 patients (11.1%) Type III with Cortical Mastoidectomy (Group5): one patient (3.7%) Type III with Modified Radical Mastoidectomy. They had a mean Air-Bone gap improvements were (9.66 dB), (17.4 dB), (13.2 dB), (9.60 dB) and (5.54 dB) respectively. The overall graft success rate was (92.5%). Conclusion: Significant improvement was noted in the subjective symptom of hearing loss following the tympanoplasty procedures. The mean Air-Bone gap closure was greatest for type I with cortical mastoidectomy; followed by type II with Cortical Mastoidectomy, type I alone and then type III with Cortical Mastoidectomy. Modified radical mastoidectomy was associated with the least hearing improvement as otherwise.