Results Of Tympanoplasty Research Articles

Age-Related Impact on Tympanoplasty Results in Adult Individuals: Prospective Observational Study

Age-Related Impact on Tympanoplasty Results in Adult Individuals: Prospective Observational Study

Audiological Outcome of Tympanoplasty With Mastoidectomy in Middle-Aged and Younger Patients With Chronic Otitis Media

Audiological Outcome of Tympanoplasty With Mastoidectomy in Middle-Aged and Younger Patients With Chronic Otitis Media

Outcomes of Microscopic vs. Endoscopic Tympanoplasty at a Tertiary Healthcare Institution in Western Maharashtra.

Introduction Chronic suppurative otitis media (CSOM) involves tympanic membrane perforation and is traditionally treated with microscopic tympanoplasty. Recent advancements in endoscopic techniques offer enhanced visibility and outcomes. This retrospective study compares endoscopic and microscopic tympanoplasty outcomes in CSOM patients between 2023 and 2024. Aim This study aims to evaluate outcomes of endoscopic vs. microscopic tympanoplasty in patients suffering from CSOM who are presenting at our tertiary care center. Methodology A retrospective study of 100 patients of CSOM undergoing tympanoplasty. Sixty patients underwent microscopic tympanoplasty and 40 endoscopic tympanoplasty. Postoperative successful uptake of graft and resultant hearing were compared between the two groups. Results Ninety-seven out of 100 patients had a successful graft uptake at three months. Fifty-eight patients in the microscopic tympanoplasty group (96.67%) and 39 in the endoscopic group (97.5%) had healed the tympanic membrane at three months of follow-up (p = 0.864). At postoperative three months, no statistically significant difference was found in the improvements in air conduction levels of the two groups (p = 0.995). No significant difference in the air-bone gap between the two groups (p = 0.095). The average air-bone gap at three months postoperative was 7.95 ± 4.20 decibel (dB) in the microscopic tympanoplasty group and 7.80 ± 4.10 dB in the endoscopic tympanoplasty group (p = 0.680). The incidence of postoperative wound area pain, numbness, and ear discharge was significantly higher in patients undergoing microscopic tympanoplasty (p < 0.05). Conclusion The two methods did not significantly differ in terms of the outcome of the hearing test or the rate of graft uptake. However, a better result was noted in endoscopic tympanoplasty compared to the microscopic tympanoplasty group. Postoperative complications encountered were less in the endoscopic tympanoplasty group.

Study of Predictive Value of Middle Ear Risk Index on Hearing Improvement in Patients Undergoing Surgery for Chronic Suppurative Otitis Media

Introduction: Middle ear risk index is one of the most reliable measuring tools to predict and evaluate the results of tympanoplasty. This study was done to analyse the predictive value of revised middle ear risk index on hearing improvement in patients undergoing surgery for chronic otitis media and to correlate the association between each index factor with hearing results. Materials and Methods: This prospective observational study was done over 2 years in a tertiary care Army Hospital with 88 patients in the age group of 10-65 years. Preoperative hearing thresholds and air-bone gaps were recorded. Patients were assigned to mild, moderate and severe groups with risk index scores. Hearing thresholds were assessed at 3 and 6 months following surgery for chronic otitis media. Data was statistically analysed. Results: 92.04% and 77.27% showed hearing improvements, 4.54% and 1.13% had deterioration and 3.40% and 21.59% had no change when compared to preoperative results in AC and BC thresholds respectively. 57.95% had post-operative closure of air bone gap of ≤ 12. Compared to cases with AB gap closure ≤ 12, those with AB gap closure &gt; 12 showed statistically significant gain in BC by 0.2dB. Each unit increase in risk index score was associated with statistically significant increase of 0.64 dB in BC. Out of the seven individual factors, only perforation and previous surgery showed statistical significance in terms of hearing improvement. Conclusion: Middle ear risk index is not a good predictor of hearing improvement in ear surgery. Individually, risk index or air bone gap are not strong predictors but jointly, they show strong association with hearing improvement both in terms of AC and BC. Keywords: Middle ear risk index; Air conduction; Bone conduction; Air-bone gap; Hearing improvement.

The Role of the Middle Ear Risk Index in the Outcome of Tympanoplasty in Terms of Graft Uptake and Hearing Improvement

The Role of the Middle Ear Risk Index in the Outcome of Tympanoplasty in Terms of Graft Uptake and Hearing Improvement

Reply to Ronsivalle, S.; Di Luca, M. Exploring the Choice of Graft Materials in Tympanoplasty: A Perspective on the Use of Temporalis Fascia and Cartilage Grafts. Comment on "Ferlito et al. Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective. J. Clin. Med. 2022, 11, 7000".

We sincerely appreciate the valuable insights Ronsivalle et al [...].

Exploring the Choice of Graft Materials in Tympanoplasty: A Perspective on the Use of Temporalis Fascia and Cartilage Grafts. Comment on Ferlito et al. Type 1 Tympanoplasty Outcomes between Cartilage and Temporal Fascia Grafts: A Long-Term Retrospective Study. J. Clin. Med. 2022, 11, 7000.

I am writing this letter to discuss and share my thoughts on the recently published research comparing the outcomes of using temporalis fascia and cartilage grafts in type I tympanoplasty [...].

Effectiveness of middle ear risk index (MERI) in outcome of tympanoplasty

Effectiveness of middle ear risk index (MERI) in outcome of tympanoplasty

Comparison of the Impacts of Different Middle Ear Mucosal Conditions on Type I Tympanoplasty Outcomes.

This study aimed to explore the impacts of different middle-ear mucosal conditions on the outcomes of type I tympanoplasty. A retrospective analysis of 164 patients with chronic otitis media was carried out. The patients were divided into 4 groups according to their mucosal condition. Preoperative hearing levels and air-bone gap (ABG) before and after surgery were compared via the Kruskal‒Wallis H test. The chi-squared test and Fisher's exact test were used to assess the postoperative complications and impact factors of functional success. Preoperatively, neither the air conduction nor bone conduction values differed significantly among groups with different mucosal conditions. All of the ABG closed dramatically after type I tympanoplasty (P < .05) regardless of the mucosal conditions. The functional success rates were lower when the intratympanic mucosa was moderately or severely edematous compared with mildly edematous or normal (P < .05). The disease course, perforation site, and perforation size, as well as the status of the opposite ear, were not related to the auditory functional outcome. The differences in postoperative reotorrhea and reperforation among the 4 groups were not statistically significant. Preoperative hearing levels were not affected by middle-ear mucosal conditions. The functional success rate was influenced by mucosal conditions, but hearing levels were significantly enhanced after surgical intervention regardless of the mucosal status. Postoperative complications were not related to the mucosal conditions. Thus, type I tympanoplasty is adoptable for mucosal abnormalities when pharmacotherapy cannot result in a healthy tympanum.

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.

Comparative Study of the Outcome of Tympanoplasty Alone with Tympanoplasty Combined with Cortical Mastoidectomy in Patients with Quiescent Mucosal Chronic Otitis Media

ABSTRACT Aims: 1. To compare the outcome of tympanoplasty alone with tympanoplasty combined with cortical mastoidectomy in patients with quiescent Chronic otitis media (COM). 2. To assess gain in hearing in dB. Materials and Methods: Patients diagnosed with mucosal type of chronic otitis media in the quiescent stage were selected. Two groups were formed. Patients were selected randomly and alternately they were included in groups A and B. The patients underwent otomicroscopy. Pure tone audiometry would depict pure conductive hearing of hearing loss. Group A (50% patients) were subjected to tympanoplasty alone and group B (other 50% patients) were subjected to tympanoplasty combined with cortical mastoidectomy. Prior to surgery, all patients underwent routine blood and urine examination, pure tone audiometry, and B/L mastoid X-ray Schuller’s view. Results: In our study, hearing gain in decibels in the tympanoplasty group was 17.1% and in tympanoplasty combined with cortical mastoidectomy was 21.1%. Graft uptake was 94% in the tympanoplasty group and 96% in tympanoplasty combined with cortical mastoidectomy. Recurrence of discharge was seen in three cases of tympanoplasty. Though tympanoplasty combined with cortical mastoidectomy is better in hearing improvement, graft uptake but the difference in two groups is statistically insignificant. Conclusion: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis. Media: Clinical significance: Hearing improvement and graft uptake were statistically insignificant in two groups. Combining cortical mastoidectomy with tympanoplasty will not give additional benefits in terms of hearing gain and graft uptake in patients with quiescent mucosal chronic otitis media.

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.

Use of platelet rich fibrin in tymapnoplasty

An observation study was undertaken at Department of Otorhinolaryngology, AIMSR fromJan 2021 – Aug 2022. The aim of my study the efficiency of use of autologous platelet rich fibrin membrane along with temporalis fascia in closure of tympanic membrane perforation during tympanopasty. All the patients attending ENT OPD at AIMSR within the age group of 11-60 years, irrespective of sex with tubotympanic CSOM either unilateral or bilateral were included in this study. In our study of 50 patients, 42 patients had graft uptake and 8 had failure of graft. Through this study we concluded that. The outcome of tympanoplasty does not depend on age and sex, dry ear of more than 6 month has a better graft.

A clinical study of mastoid ventilation tube in tympanoplasty

Background: A ventilated middle ear space is an essential component of a functioning middle ear transformer mechanism. A mastoid ventilation tube (MVT) placed post-aurally in the antrum near the aditus is used in this study for the benefit of improvement in results of tympanoplasty. In support of this concept, very few experimental documents are reported. Aims and Objectives: The aims of this study were to find out if the MVT has any effect on the outcome of tympanoplasty in cases of chronic suppurative otitis media (CSOM) tubo-tympanic disease. Materials and Methods: This study was performed in 50 cases which were selected from the total number of cases using stratified random sampling method. In the research, patients with CSOM, who did not respond to medical therapy and required a combined approach tympanoplasty, were enrolled. Patients who needed just myringoplasty and those found to have cholesteatoma intraoperatively were not included in the research. Results: The study showed significant improvement in graft uptake, air-bone closure, and hearing in cases with MVT, thus resulting in better success rate in cases with MVT than cases without MVT. Furthermore, most of the cases had sclerosed mastoids and very few cases had complications such as MVT block and post-operative discharge. Conclusion: The MVT had a beneficial effect on the final outcome of combined approach tympanoplasty in cases of CSOM tubo-tympanic type active stage.

Investigation of factors affecting pediatric type 1 endoscopic tympanoplasty results and success rates of surgery

ObjectiveThere are many factors that affect the results of tympanoplasty in children. Recurrent ear infections, hearing loss, and more serious complications due to cholesteatoma may be observed. This study examined factors affecting the success of type 1 endoscopic tympanoplasty surgery in pediatric patients and investigated recommended procedures to increase the success of the operation. MethodsOur study included pediatric patients who underwent type 1 endoscopic tympanoplasty operation for chronic otitis media. Patient files were analyzed retrospectively. Hearing results before and after the operations were recorded.. Patients were divided into groups according to gender, age (<12 age group, ≥12 age group), and perforation type. Hearing results and physical examination findings were compared for each group. ResultsA total of 204 pediatric patients were included in our study: 114 were male and 90 were female. Patients’ hearing results were compared according to the size and location of their tympanic membrane perforations. Hearing loss was found to increase as the size of the tympanic membrane perforation increased. In addition, it was observed that perforations in the posterior quadrant caused more severe hearing loss than in the other quadrants. The postoperative results of the two groups <12 years old, and ≥12 years old were evaluated according to age. Postoperative improvement was higher in the ≥12 age group compared to the <12 age group. ConclusionAccording to the results of this study, tympanoplasty surgeries performed on patients younger than 12 have a decreased success rate. Among the many factors that affect the success of an operation, age is one of the most important. There are many factors that affect the results of the operation, perforation size and localization is one of them. There are many factors that affect the success of surgery such as pediatric patients and adult patients. It is useful to make a personal evaluation and to plan the surgery by evaluating the obstacles such as eustachian tube maturation and difficulty in postoperative care in pediatric patients.

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

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

Radiological Anatomy of Eustachian Tube and its Correlation with Graft Uptake in Type I Tympanoplasty

Introduction: Eustachian tube (ET) also known as pharyngotympanic tube connects nasopharynx with the middle ear. Evaluation of ET anatomy is aimed in patients with chronic otitis media. Materials and Methods: In a study of 53 patients, HRCT Temporal bone was done on 128 dual source simens somatom definition flash machine on 5mm cut section and tympanoplasty was carried out. Results: ET angle is one of the important factors for middle ear aeration. Outcome of tympanoplasty at 12th week was 88.7%. In the patients with vertical Eustachian Tube (i.e., more Eustachian Tube angle with the horizontal plane), better graft uptake in tympanoplasty was observed which was statistically significant. However, graft uptake did not correlate with the length of the Eustachian tube. Conclusion: It was concluded that on measuring ET length on HRCT, majority of the patients had bony length of 10-12 mm, cartilaginous length of 15-19 mm and total ET length of 28-32 mm. Majority of the patients had ET angle of 21-30 degrees with the hard palate.

Role of Middle Ear Risk Index in the Selection of Middle Ear Surgery and Factors Determining Outcome: A Cross-sectional Study

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from comorbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p&lt;0.05. Results: The MERI was utilised as a tool for assessing surgical outcomes. A lower MERI score indicated a less invasive choice of middle ear surgical procedure and was associated with a better outcome in terms of graft uptake, which was statistically significant. Patients requiring tympanoplasty alone had mild MERI scores (1-3), while more extensive surgeries such as canal wall up or canal wall down were associated with moderate or severe MERI scores (4-6 or 7-12), and this association was found to be significant (p=0.001). Interestingly, out of the total 40 patients, five with Eustachian Tube (ET) dysfunction had severe MERI scores (7-12) and experienced graft rejection. Patients with lower grades of ET dysfunction had higher chances of graft uptake, and this association was statistically significant (p=0.001). Conclusion: This study demonstrated that lower MERI scores were associated with better postoperative outcomes. In a country like India, where the cost of surgery and time away from work are major considerations, it is important to establish a standardised approach to predict the surgical outcome, whether it involves tympanoplasty alone or in combination with other middle ear surgeries like cortical mastoidectomy or canal wall down mastoidectomy, and counsel the patient accordingly. This plays a crucial role in informed decision-making.

A STUDY OF TYMPANOPLASTY AND ITS OUTCOME IN VARIOUS AGE GROUPS USING THE MIDDLE EAR RISK INDEX SCALE

troduction: Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem world-wide especially in developing countries where large percentage of the population lacks specialized medical care. With a large number of patients frequently undergoing tympanoplasty for chronic suppurative otitis media (CSOM), it is important to assess the severity of the disease and predict the outcome of the surgical management.Aims: To study MERI and result of tympanoplasty according to the risk category. Materials and Methods: The present study was a Prospective study. This Study was conducted from November 2021 to November 2022 at Department of Ear, Nose, and Throat (ENT), Patna Medical College &amp; Hospital , Patna, Bihar, India. Result: In our study, Forty-nine of the 58 patients had unilateral and 18 had bilateral perforations. The surgical success rate was 92% in the former and 78% in the latter group (P =0.67). Conclusion: Our study showed that myringoplasty is a good treatment modality in the paediatric population and MERI scoring can be useful in predicting the outcome of tympanoplasty in all age-groups.

Outcome of Tympanoplasty with Cortical Mastoidectomy in Tubotympanic Type of CSOM

Background: Chronic suppurative otitis media (CSOM) is one of the most common ear diseases in under developing countries. Otolaryngologists debate whether to perform tympanoplasty with or without cortical mastoidectomy when treating CSOM. Objective: To see the outcome of tympanoplasty with cortical mastoidectomy for hearing gain and grafting success. Methods: This observational study was carried out in the Department of Otolaryngology - Head and Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka from July 2018 to June 2020. A total of 30 patients who underwent type 1 tympanoplasty with cortical mastoidectomy were enrolled in this study. Following enrollment, the condition of the pinna, preauricular region, postauricular region, and external auditory canal were examined. The location and extent of the tympanic membrane perforation, the state of the remaining tympanic membrane, the health of the middle ear mucosa, and the ossicles were all examined during the otoscopy. Tuning fork tests, tests for facial nerve integrity, and fistula tests were also carried out. The hearing level was assessed by pure-tone audiometry with masking. Results: Among 30 patients’ females were 53.3% and males were 46.7%. All of the patients ranged in age from 16 to 60, with the majority of them falling between the ages of 21 and 30. Most of the patients came from middle-class families, and the majority of patients were from rural areas. The majority of patients showed unilateral ear involvement. Most often, the central malleolar region was perforated, then the anterior central region and the posterior central region. The most frequent perforation size was medium, followed by small, large, and subtotal. The pre- treatment bone conduction threshold was 11.74± 4.42 dB, which was reduced to 10.14 ±3.70 dB after treatment (p&lt;0.05). The pre-treatment air conduction threshold was 39.78± 8.76 dB, which was reduced to 26.45 ±9.19 dB after treatment (p&lt;0.05). The pre-treatment air-bone ..