Tympanoplasty Surgery Research Articles

Comparison of nalbuphine and propofol verses pentazocine and promethazine in tympanoplasty surgeries under monitored anesthesia care

Background: A middle ear surgery (tympanoplasty), is done under various modes of anaesthesia such as local anaesthesia (LA), general anaesthesia (GA) or sedation with local anaesthesia (MAC). It is usually performed under MAC providing advantages of rapid onset, allowing hearing test intraoperatively and early mobilization of the patient. Aims and Objectives: The aim of this study was to compare effectiveness of nalbuphine and propofol with pentazocine and promethazine combination for intraoperative sedation under monitored anesthesia care for tympanoplasty under local anesthesia (LA). Materials and Methods: A total 60 patients undergoing tympanoplasty under LA divided in to two groups randomly to receive either IV nalbuphine (50 mcg/kg) and propofol 750 mcgs/kg in 10 min followed by a maintenance infusion at the rate of 25 mcg/kg/min. Group N or pentazocine 0.6 mg/Kg and Inj. Promethazine 0.5 mg/kg IV diluted in 10 ml normal saline over 10 min followed by 25 mcg/kg/min infusion of normal saline (Group P). Sedation was titrated to Ramsay Sedation Score (RSS) of 3. Vital parameters such as HR, BP, SpO2, RSS, visual analog scale score (VAS), requirement of rescue analgesics, mean bleeding score, and surgeon satisfaction score (Likert Scale) were recorded and analyzed. Results: RSS was higher and VAS score was lower in Group N at 30, 60, 90, and 120 min (P<0.05) that mean bleeding score was lower in Group N as compare to Group P which was statistically significant. Conclusion: Nalbuphine and propofol combination are superior to pentazocine and promethazine combination in terms of producing better analgesia, sedation with batter surgical field.

The Effect of Age on the Results of Tympanoplasty Operation in Pediatric Patients

The Effect of Age on the Results of Tympanoplasty Operation in Pediatric Patients

Impact of cubism graft on the outcome of tympanoplasty surgery

Background: Tympanoplasty is a widely performed surgery for the repair of tympanic membrane perforation. Aim of the study: to compare the auditory and anatomical outcomes between two different techniques in tympanoplasty: the first with temporalis facia graft + the new “cubism” graft and the other with temporalis facia graft alone. Patients and methods: A prospective, randomized study was conducted in Otorhinolaryngology Head and Neck Surgery Department, Al-Azhar University Hospital (Damietta). Results: Cubism graft group wasn't significantly different to Temporalis fascia only group regarding ABG (p= 0.233). The ABG gain 3 month in Cubism graft group ranged from 14 to 17.5 with mean ± SD = 16.17 ± 1.15 while in Temporalis fascia only group the ABG gain 3 month ranged from 10 to 16 with mean ± SD = 14.12 ± 1.91 with statistical significant difference (p= 0.005) between the two groups. Conclusion: The novel “cubism” graft technique offers many advantages. Cartilage grafts can be thinned harmlessly while obtaining a convenient additional material in this technique. This hybrid, cartilaginous dust and PRF mixture graft can be used widely in tympanoplasty. We experienced that both functional and anatomical outcomes of this graft are very satisfying.

Video Learning of Surgical Procedures: A Randomized Comparison of Microscopic, 2- and 3-Dimensional Endoscopic Ear Surgery Techniques.

Video learning of surgical procedures helps trainees gain an initial understanding of the complex anatomy and the surgical procedure. Because no comparative studies have yet examined which microsurgical approach to the middle ear is most suitable for video learning, the authors investigated objective and subjective outcomes for medical trainees observing microscopic, 2-dimensional (2D) endoscopic, and 3- dimensional (3D) endoscopic ear surgeries. Sixty-two medical students (min. 3rd year) from the University Hospital of Bern watched three standardized videos of a type I tympanoplasty surgery recording, conducted with a microscope, a 2D endoscope, and a 3D endoscope, respectively. The authors measured participants' learning outcome, eye movements, cognitive load, and subjective preferences. Of the 62 participants included in the study, 14 were male (22.58%), and mean age was 24.44 years (range: 21-29). Learning outcome was highest after watching the 3D endoscopic video (mean [SD], 59.48% [20.57%]). Differences in score were statistically significant: 2D endoscopic video (mean difference: -6.56%, 95% CI: -13.02 to -0.10%), microscopic video (mean difference: -13.82%, 95% CI: -20.27 to -7.36%). Participants showed lowest average eye fixation duration when watching the 3D endoscopic video (mean [SD], 307 ms [109 ms]), with statistically significant differences to the 2D endoscopic video (mean difference: -139 ms, 95% CI: -185 to -93 ms), and the microscopic video (mean difference: -264 ms, 95% CI: -310 to -218 ms). Participants reported lowest cognitive load for the 2D and 3D endoscopic videos. Ratings on discomfort, usability, naturalness, depth perception, and image quality were in favor of the 3D endoscopic video. The 3D endoscopic technique offers many advantages for video learning in terms of knowledge gain, visual field exploration, and subjective evaluation. To optimize learning effects in trainees, the authors recommend the use of endoscopes in middle ear surgery and, if available, using 3D technology.

Clinicoradiological correlation of type 1 tympanoplasty in wet and dry ears

<p><strong>Background:</strong> Chronic otitis media patients can present with a dry or wet ears (which means those ears which have a mild mucoid discharge and are negative on culture). Preoperative HRCT scans done in these patients show either a normal or an opacified mastoid cavity. This creates a dilemma in the mind of an otologist as whether doing a tympanoplasty in a patient with an active mucoid ear discharge would be beneficial or not. The goal of this study is to compare results of type 1 tympanoplasty in wet and dry mucosal COM ears and correlate between preoperative CT findings and postoperative outcomes.</p><p><strong>Methods:</strong> A comparative study was done where a total of 30 wet and 30 dry ears respectively were included based on a preset clinical criterion. After a detailed history, otoscopic examination, pure tone audiometry (PTA) and a HRCT scan of temporal bone, all patients underwent type 1 tympanoplasty followed by PTA assessment 2 months postoperatively.</p><p><strong>Results:</strong> The graft uptake rates and hearing outcomes after surgery were found to be similar in both wet and dry ears. Also, the graft uptake rates in patients with opaque mastoids were similar to those with normal mastoids on HRCT scans.</p><p><strong>Conclusions:</strong> This study concludes that success of type 1 tympanoplasty surgery is not adversely affected by the presence of mucoid discharge at the time of surgery. For achieving good surgical success, meticulous graft placement is more important rather than status of the operated ear.</p>

Tympanoplasty and adenoidectomy in children: Comparison of simultaneous and sequential approaches.

The authors sought to compare simultaneous and sequential tympanoplasty and adenoidectomy surgery in pediatric patients. This retrospective single-center study included 65 children (36 males, 29 females; mean age 9.16 ± 3.82 years; range 3-17 years) requiring both tympanoplasty and adenoidectomy. Simultaneous surgeries were performed on the same day, during single general anesthesia, whereas sequential surgeries were separated at least 12 weeks. The groups were compared with regard to restoration of hearing, tympanic membrane status, and utilization of medical resources. All study participants had a 12-months follow-up period after surgery. No statistically significant differences were observed between the groups regarding pre- and post-operative ABG values and average hearing gains. However, the post-operative ABG was significantly lower than the pre-operative ABG in both groups (p<0.001). There were no significant differences between simultaneous and sequential groups with respect to complete healing rates and complications (all p>0.355). Simultaneous tympanoplasty and adenoidectomy surgery management is associated with a significantly decreased cumulative hospital stay, cumulative operating room time, and cumulative pure surgical time (all p≤0.016). The results of first comparative study of simultaneous versus sequential tympanoplasty and adenoidectomy surgery managements demonstrate no advantages for the sequential approach. The same-day surgery can show the clinical outcomes comparable to those in the sequential group. The simultaneous surgery approach appears to be associated with reduced medical resources consumption. Therefore, simultaneous surgery management is an effective and safe option for children with chronic otitis media and adenoid hypertrophy.

Correlation between the perforation size and patency of eustachian tube and graft uptake in intact canal wall tympanoplasty surgery: a study of 32 benign-type chronic suppurative otitis media patients

Background: Factors that contribute to the success of Intact canal wall Tympanoplasty have yet to be certainly known. Several studies show varied success rates and success criteria. Objective: To investigate the correlation between the perforation size and patency of Eustachian Tube and the results of graft uptake on benign-type chronic suppurative otitis media patients that undergo intact canal wall tympanoplasty surgery. Methods: This research used observational descriptive analysis. The participants were patients diagnosed with benign-type chronic suppurative otitis media who were treated with intact canal wall tympanoplasty surgery in 2018. Data such as demographic data, smoking history, clinical findings including perforation size of tympanic membrane, Eustachian Tube patency, results of pure-tone audiometry examination, results of graft uptake, and type of Tympanoplasty were collected from each participant. The statistic tests in use included contingency coefficient correlation test and Fisher exact test. Result: Most of the participants were male (53.13%), the average age was 28.03 ± 12.32 years old, and most participants do not smoke (71.87%). The overall graft uptake success rate is 71.87% (n = 23), while the failure rate is 28.12% (n = 9). Pure Tone Average (PTA) was 37.19 dB at pre-op and 25.79 dB at post-op, which is a significant improvement (p=0.000) with average hearing improvement (PTA-Gain) of 15.75 dB. The patent Eustachian Tube functions give the best graft uptake results of 88.90%, followed by partial patency at 75% and non-patent at 40% (p=0.020). The highest average of PTA in non-patent function of the tube is 20.94 dB. Hearing threshold improvement (PTA-Gain) on patent, partial, and non-patent ETF groups differs significantly (p=0.046). Results of graft uptake on small and medium perforation size show the highest rate of (81.80%), followed by large perforation (50%). The highest PTA in total perforation size is (18.90 dB), then medium (15.14 dB), and small (6.22 dB). The perforation size of TM before surgery does not correlate with the success of graft uptake (p=0.297). The size of perforation correlates with improvement of hearing threshold (p=0.011). Conclusion: Eustachian Tube’s function has correlation with the success of graft uptake and hearing threshold improvement (PTA-Gain), while the perforation size of TM before surgery correlates with hearing threshold improvement (PTA-Gain).

Investigation of the Effects of Lavender Oil Aromatherapy to Prevent Preoperative Anxiety in Patients Scheduled for Tympanoplasty

Objective: Anxiety is a common problem before surgical procedures. The effectiveness of aromatherapy in preoperative anxiety control has been demonstrated by some studies. The aim of this study is to investigate the effects of lavender oil inhalation on anxiety levels in patients before ear surgery. Material-Method: The study was conducted in the Otorhinolaryngology clinic of a tertiary university hospital. A total of 68 patients (34 in the study group, 34 in the control group) who were scheduled for tympanoplasty operation were included in the study. Inhalation of lavender oil was used in the patients in the study group before the operation, and liquid paraffin was used in the control group. A personal information form and State-Trait Anxiety Scale (STAI) were used to collect data.Results: In the study group, the mean STAI pre-test and post-test mean scores were 44.50 ± 12.38 and 36.48 ± 10.73, respectively, and there was a statistically significant difference (p &amp;lt;0.05). These values were 45.60 ± 12.35 and 41.83 ± 10.78, respectively, in the control group, and the difference was not statistically significant (p&amp;gt; 0.05). Also, when the posttest STAI mean scores were evaluated between the study and control groups, a statistically significant difference was found (p &amp;lt;0.05).Conclusion: Lavender oil inhalation before ear surgery has been found to reduce anxiety levels in patients.

Outcomes following tympanoplasty surgery using porcine-derived small intestinal submucosa.

To determine the outcomes of tympanoplasty surgery using porcine-derived small intestinal submucosa. A retrospective audit was conducted in a hospital setting. Thirty-five adult and paediatric patients who received a small intestinal submucosa graft as part of tympanoplasty surgery were retrospectively reviewed. Patients underwent either simple tympanoplasty (n = 26) or complex tympanoplasty as part of a concurrent otological procedure such as atticotomy and mastoidectomy. The main outcome measures were rate of tympanic membrane closure and change in four-frequency mean air-bone gap. Thirty-one patients had a follow-up period of longer than two months. Closure was obtained in 22 patients (71 per cent). The mean air-bone gap improved from 20.7 to 12.3 dB HL in the simple tympanoplasty group and from 22.3 to 12 dB HL in the complex tympanoplasty group. Tympanoplasty surgery with small intestinal submucosa is a viable option for patients where autologous graft is not available or in order to minimise donor site morbidity.

Trainee-trainer outcomes in mastoid surgery: a comparative study.

Mastoid exploration remains an advanced, mainstay operation within ENT, in which the surgical trainees' role has been debated. This audit compares mastoid exploration outcomes between trainees and consultants. Cortical mastoidectomy, atticotomy, atticoantrostomy, modified radical mastoidectomy, combined-approach tympanoplasty and revision mastoidectomy operations performed between 2009 and 2020 were reviewed. Complications assessed were: facial palsy, labyrinth injury, dead ear, disease recurrence and time to recurrence. The chi-square test was used to determine significant associations. A total of 118 operations were surveyed. Thirty-five per cent of procedures (n = 41) were performed by trainees under supervision, and 65 per cent (n = 77) were carried out solely by consultants. Patients from 5 per cent of trainees' operations (n = 2) developed recurrence, compared with 7.8 per cent of consultants' (n = 6) (p = 0.55). No other complications developed in either group. The results corroborate those of other studies, indicating no significant increase in complication rate from consultants to trainees. Trainees likely completed less complicated cases. The stepwise incorporation of trainees did not compromise patient safety.

Radiological Follow-up After the Bony Obliteration Tympanoplasty in Detecting Residual Cholesteatoma: Towards an Optimal Postoperative MR Imaging Protocol.

There is no consensus in literature on the most optimal follow-up imaging protocol for non-echoplanar diffusion-weighted magnetic resonance imaging (non-EP DW MRI) after the canal wall-up bony obliteration tympanoplasty. Clearly, no residual cholesteatoma should be missed but on the other hand, unnecessary MR controls should be avoided. The aim of this study is to evaluate the postoperative results of non-EP DW MRI after canal wall-up bony obliteration tympanoplasty surgery at our Institute and to propose an optimal postoperative MR imaging scheme based on our data. Retrospective cohort study; all 271 patients who underwent the bony obliteration tympanoplasty between January 2010 and January 2016 with follow-up at our Institute were included. A postoperative MR imaging was systematically performed at 1 year after surgery and repeated at either 5 or both 3 and 5 years after surgery, based on the preferences of the surgeon. Variables of interest were retrieved from electronic patient records. The median follow-up time was 60 months (inter-quartile range 56-62 mo). Two hundred seventy-one patients (100%) received a 1-year MRI, 107 (39%) a 3-year MRI, and 216 (79.7%%) a 5-year MRI. Residual cholesteatoma was found in nine cases (3.3%), corresponding with an estimated residual rate at 5 years follow-up of 3.7% when using Kaplan-Meier analysis. Of these nine cases, six cases of residual cholesteatoma (66.7%) were detected at the 1-year MRI (12-14 mo postsurgery), two cases (22.2%) at the 3-year MRI (35-39 mo postsurgery), and one case (11.1%) at the 5-year MRI (51 mo postsurgery, in this patient no 3-year MRI was performed). An uncertain MRI result was found in 15 cases, presenting as relatively hyperintense lesions. However, subsequent follow-up scans did not show persistent evidence for residual disease in 14 of these 15 cases. A postoperative MRI scan after 1 and 5 years is essential to detect early and late residual cholesteatoma. In our cohort, 22.2% of residual cases were detected at the 3-year MRI. However, this percentage could potentially have been higher when all patients would have received a 3-year MRI. Therefore, in order to detect residual disease as soon as possible, we propose to perform an MRI scan at 1, 3, and 5 years after the bony obliteration tympanoplasty. In cases with an unclear MR result, we suggest a repeat MRI after 12 months.

Composite gelfoam/fascia graft: a novel technique in tympanoplasty surgery.

Traditional tympanoplasty techniques require graft placement and then supporting material (GelFoam) as a two-step process. Both steps potentially disrupt accurate graft placement leading to failure and persistence of the perforation. We demonstrate a novel technique for graft preparation and placement using composite gelfoam/fascia in which the gelfoam and fascia are compressed into a common layer and applied to the perforation and drum remnant in a single step. Placement is ergonomically efficient and effective. This novel modification of traditional graft preparation and placement is simple and ergonomically efficient.

Success Rate of Intact Canal Wall Tympanoplasty in Safe Type of Chronic Suppurative Otitis Media’ Patients

Background: Surgical therapy for chronic suppurative otitis media (CSOM) is by tympanoplasty with orwithout mastoidectomy. The purpose of surgery is to eradicate the source of infection. Success indicatorsof tympanoplasty are achieving dry ears without recurrent otorrhea, myringoplasty, and an increase in thehearing threshold.Objectives: is to know the success rate of intact canal wall tympanoplasty in safe type CSOM patients.Methods: Retrospective descriptive was used in this study. All safe-type of CSOM patients undergoing intactcanal wall tympanoplasty surgery from January to December 2018 at Dr. Soetomo General Hospital were usedas the participant data.Results : There were 32 participants, divided into a higher proportion of males than females (ratio 1.1:1). The characteristics of the participants included; the most age group were 21-30 years (37.50%), originoutside Surabaya (59.37%), and high school education level (62.50%). Most perforations were subtotal(40.63%) and hearing loss was conduction (62.50%). Apparently, 56.25% were patent Eustachian tubes,90.63% were sclerotic mastoid Schuller photographs, and 62.50% were granulation tympanic cavity findings.Additionally, 78.13% were performed tympanoplasty type 1. The results of postoperative eradication showeddry ears (84.38%) and successful of myringoplasty (71.88%). The mean increase in the hearing threshold forAC, BC, and ABG after surgery was 15.98 dB, 4.57 dB, and 11.40 dB.Conclusion: The results of eradication after intact canal wall tympanoplasty were mostly dry ears, successfulmyringoplasty, and an increase in the mean hearing threshold of AC, BC, and ABG.

The Effect of Anteriorly Located Sigmoid Sinus on Postoperative Hearing Gains: A Case-Control Study.

There are many studies on the effects of temporal bone anatomical variations on a mastoid pneumatization. Considering the effects of the anatomic variations on mastoid pneumatization, it is considered that many anatomic variations may affect graft success rates and postoperative hearing threshold gains. We aimed to evaluate the effects of various anatomic variations on postoperative hearing gains among patients undergoing tympanoplasty. This retrospective cohort study conducted in a tertiary-care university hospital. This study enrolled 57 patients who underwent primary type 1 tympanoplasty operation using the temporal muscle fascia. The patients were divided into two groups as those with an anteriorly located sigmoid sinus (group 1), and no anatomic variation (group 2). Airway gain values at the frequency range of 250Hz-8000Hz and pure tone average (PTA) value were calculated preoperatively and at postoperative sixth month. The gains attained by the patient groups with anatomic variations were compared with group 2. There were significant differences between Group 1 and Group 2 in terms of the airway frequencies of 250, 500, 2000, 4000Hz, and PTA value. We detected a lesser postoperative hearing gain in patients with an anteriorly located SS. We believe that anatomic variations that may affect middle ear and mastoid cavity may also affect postoperative hearing gain.

Does Eustachian tube function affect the outcome of tympanoplasty?

BackgroundEustachian tube function has been regarded as a significant factor in the successful outcome of tympanoplasty. Eustachian tube dysfunction has been attributed to many diseases of middle ear cleft ranging from otitis media with effusion to unsafe chronic otitis media. The aim of this study is to evaluate the effect of Eustachian tube function on outcome of tympanoplasty in safe chronic suppurative otitis media patients and detect the correlation between the type of the used graft and the outcome of tympanoplasty. This study included 60 randomly selected patients diagnosed with safe chronic suppurative otitis media. Eustachian tube function was tested with tympanometry and Toynbee’s test. All patients underwent tympanoplasty type I.ResultsSuccessful statistically significant outcome was observed in 83.3 % of patients with normal eustachian tube function, while in 60 % of patients with eustachian tube dysfunction (p < 0.05).ConclusionEustachian tube function significantly affects the outcome of tympanoplasty surgery. No significant correlation was noted between the type of the used graft and the outcome of tympanoplasty.

Fistulae of the Canal Lateral Due to Cholasteatomatous Otitis About 5 Cases

Our study is retrospective on 5 cases of fistulae of the lateral semi-circular duct (CSCL) complicating chronic cholesteatomatous otitis media, operated in the otolaryngology department of the CHU HASSAN II of Fez, over a period of 4 years from January 2014 to December 2017. The age of our patients ranged from 6 years to 65 years with a mean of 26 years, and a clear male predominance. The consultation period ranged from 1 year to 15 years. Othorrhea and vertigo were consistent in all our patients, combined with mixed deafness in 3 patients. The otoscopy revealed several aspects; going from image Typical a cholesteatoma of the middle ear with epidermal scales in the middle ear emerging from a perforation or a tympanic retraction pocket, or an attical cholesteatoma on a stage III retraction pocket. Ossicular lysis was evident in 3 of patients. Peripheral vestibular syndrome was noted in all of our patients. Neurological examination found a case of facial paralysis. Concerning the functional impairment; 2 of our patients had pure transmissive deafness, the remaining 03 patients had mixed deafness. Diagnosis labyrinthine fistulae has been clinically evoked and surgically confirmed. All our patients received preoperative CT scan. MRI has a complementary and fundamental role in the diagnosis of some internal ear disorders, it was requested in one patient. Treatment of fistulae (CSCL) was achieved by plugging the breach with temporal aponevrosis associated with the treatment of Chronic cholesteatomatous otitis. In our series, all our patients received general antibiotic therapy adapted to the antibiogram, 3 patients received treatment with open tympanoplasty wall down patients received tympanoplasty by closed technique. The surgical follow-ups were simple.

Endoscopic transcanal management of tympanosclerosis.

The objectives of this study are to describe our experiences in endoscopic transcanal management of tympanosclerosis, to explain our surgical approaches to reconstruct the sound conduction system and to analyze the hearing results obtained with our surgical approaches. A retrospective cohort study, using medical records of 28 cases that underwent endoscopic transcanal tympanoplasty surgery due to tympanosclerosis from January 2016 to January 2020. Private otology clinic PATIENTS: Twenty-eight ears of 26 patients were enrolled into study. Patients were grouped according to Wielinga-Kerr classification and only type II, III and IV patients were included in the study. Exclusively transcanal endoscopic surgery was performed in all cases. Primary goal was to mobilize the affected ossicles by removing the offending TS and reconstruct the ossicular chain. Malleostapediopexy was preferred when attic by-pass procedures were needed. Glass ionemer bone cement was used to reconstruct the ossicular defects. Preoperative and postoperative pure tone average of air conduction and bone conduction and air-bone gap results were evaluated. Operation was considered successful if postoperative ABG < 20dB was achieved. Complications and graft take rate were also evaluated. Single-staged surgery was performed in 23 of 28 cases (82.1%). Graft take rate was 93%. The mean preoperative ABG significantly decreased from 33.9 ± 5.19 to 12.55 ± 5.52dB postoperatively for 23 cases who had single-staged surgeries (p < 0.001, Wilcoxon signed rank test) at the end of the mean follow-up period of 23months. For this group, the mean preoperative AC-PTA significantly improved from 48.64 ± 9.30 to 22.93 ± 7.45dB (p < 0.001, Wilcoxon signed rank test) postoperatively with a mean PTA improvement of 25.71 ± 6.02dB. Success criterion was achieved in 22 of 23 cases (95.7%). There was no sensorineural hearing loss, facial nerve paralysis and postoperative vertigo after the surgical procedures. All patients had been discharged within the first 24h. Surgical treatment of tympanosclerosis is still a controversial issue. Endoscopic surgery seems a safe technique for the management of tympanosclerosis. Single-stage surgery is possible in most of the cases with a satisfactory hearing result. We speculate that addition of endoscopic view may increase the single-stage surgery ratio.

Prospective study of use of Island of tragal cartilage in revision tympanoplasty

Background: Ideal graft material in revision tympanoplasty is a topic of much research. Cartilage being sturdy and stable even in negative pressure situations, is a viable option. Aims and Objectives: The aim of the present study was to evaluate graft uptake and hearing improvement using the technique of island of tragal cartilage as a graft material in revision tympanoplasty. Materials and Methods: This was a prospective study of total of 60 Type 1 revision tympanoplasty surgeries which were done using tragal cartilage island graft from December 2017 to December 2019 in our institute with a follow-up of 3 months. Results: Graft uptake in our study was found to be 93.33%. Four patients showed a re-perforation during follow-up. The mean preoperative air-bone gap (ABG) was 28.13 dB, while the postoperative mean ABG was 16.83 dB and the mean gain was 12.83 dB. Conclusion: It is thus worthwhile to consider island of tragal cartilage as a graft material in revision tympanoplasty.

Outcomes of Type I Tympanoplasty using a Cartilage Shield Graft

Background: Type I tympanoplasty surgery is an effective routine technic that had been used for tympanic reconstruction to improve hearing. Objectives: The aim was to measure the effect of type I tympanoplasty surgery using the cartilage shield graft (CSG) in term of graft uptake (anatomical outcome) and hearing gains (functional outcomes) of patients with poor prognostic factors. Method and Materials: In this study, 20 patients with perforation exceeded 50%, but limited to the tympanic membrane were recruited for type I tympanoplasty surgery. The study was conducted in the Otolaryngology/Head and Neck surgery training center in Sulaimani Teaching Hospital in Sulaimani city for one year period. Bellucci classi?cation was used to evaluate otorrhea risks. Results: The majority of patients were female (90%), with a mean ± SD (standard deviation) of ages of 37.15 ± 14.01 years. Most of the patients (40%) were presented with a mild hearing loss of 26-40 decibels (dB). Type I tympanoplasty surgery using the cartilage shield graft (CSG) had significantly decreased the hearing loss and air-bone gap (p-value = 0.046 and 0.006, respectively). The mean differences in hearing loss and air-bone gap were 5.05 dB and 6.75 dB, respectively. Conclusions: CSG in type I tympanoplasty surgery is an effective solution in anatomical outcome (Graft uptake) and functional outcomes (hearing gains) which had been reflected in reducing hearing loss and air-bone gap (average hearing gain of 5dB) in patients presented with tympanic membrane perforations. No improvement in the functional outcomes was observed in patients presented with severe hearing loss pre-operatively.

Characteristics of Chronic Suppurative Otitis Media (CSOM) patients who underwent tympanoplasty surgery at Sanglah General Hospital for the period 2017 - 2019

Background: One way to deal with deafness from Chronic Suppurative Otitis Media (CSOM) is middle ear reconstruction surgery known as tympanoplasty. The success of surgery is when complete eradication of the disease is possible as well as hearing improvement. This study aims to evaluate the characteristics of chronic suppurative otitis media patients who underwent tympanoplasty surgery at Sanglah General Hospital for the period 2017 – 2019.Methods: A retrospective descriptive study was conducted through secondary data from the medical records of CSOM patients who had undergone tympanoplasty surgery at Sanglah General Hospital in Denpasar during the January 2017 - December 2019 period. Variables assessed in this study were age, sex, address of residence, infected side, perforation surface area, CT-scan, culture, surgical findings, graft type and antibiotic therapy, post tympanoplasty tympanic membrane perforation condition, audiometry results before and after undergoing tympanoplasty. Data were analyzed using SPSS version 20 for Windows.Results: Most of the respondents were male (53.3%), aged 46 - 55 years (26.7%), and living in Denpasar (30.0%). Based on the ear side, the most infected were unilateral (53.3%) and the subtotal perforation surface area (78.3%). No visible abnormalities (40.0%) were the most cases on the CT-Scan, following by the Pseudomonas aeruginosa (21.7%) infection and surgical findings in the form of tympanic membrane perforation only (55.0%). Based on the 3 months post tympanoplasty condition, it was found that the perforation had closed (83.3%), normal audiometric results (38.3%), and a degree of improvement in the hearing threshold after undergoing tympanoplasty was found to be mostly 5-10 dB (48.3%).Conclusion: CSOM patients who underwent tympanoplasty surgery were mostly men, aged 46-55 years, unilateral, subtotal perforation, and no CT scan abnormalities. In comparison, the membrane perforation condition 3 months post tympanoplasty was closed, mild deafness before tympanoplasty, normal degree of deafness after tympanoplasty, and the average mean hearing threshold improvement was 5 - 10 dB.