Tympanoplasty Surgery Research Articles

STUDY OF DIFFERENT TYPES OF GRAFT MATERIALS USE IN TYPE - I TYMPANOPLASTY AT ENT DEPARTMENT OF SKMCH, MUZAFFARPUR, BIHAR

Background: The present study was undertaken to compare the results of various autogenous tissues as grafting materials for the repair of the tympanic membrane defect. As all the materials used previously were not easily available. So the present study comprised of the materials, which were easily available in adequate amount. These were temporalis fascia, tragalperichnodrium, areolar tissue and Ear lobule fat. Methods: In 100 subjects tympanoplasty operation was performed in 100 ears. The age of subjects ranged from 11 years to 50 years with mean age being 28.9 years. 33 cases were male and 67 cases were female. Majority (62%) of them were residing in rural areas and rest (38%)were from urban population. The period of study was from May 2019 to April 2020 starting from the pre-operative assessment to post– operative follow up all findings were noted in specific proforma. All of them attended ENT outpatient department of Sri Krishna Medical College and Hospital, Muzaffarpur, Bihar, with the chief complaints of discharging ear of varying duration. Slight impairment of hearing of varying degree was also complained of. Few of them presented with active stage of the disease and they were treated conservatively so that they attained the criteria as mentioned previously for myringoplasty operation of the present study. Results: Temporal fascia – None of the operated case reached the excellent result of post operative A-B gap closure by 0 – 10 dB. 23 cases showed good A-B gap closure of 11 – 20 dB followed by 9 cases with fair A – B gap closure of 21 – 30 dB and 5 cases showed poor result of >30 dB A-B gap closure. Tragal perichondrium –None of the operated case reached the excellent result of post operative A-B gap closure by 0 -19 dB 5 cases showed good A-B gap closure by 11 -20 dB, followed by 3 cases of fair A-Bgap closure 21 – 30 dB and 1 case of poor result with >30 dB A- B gap closure. Areolar tissue – None of the operated case reached the excellent result of post operative A-B gap closure by 0 -10 dB. 6 cases showed good A-B gap closure by 11 – 20 dB, followed by 2 cases of fair i.e. 21 – 30 dB A- B gap closure. Ear Lobule fat – 8 out of 45 cases showed excellent result with post operative A-B gap closure by 0 – 10 dB followed by 32 cases with good A-B gap closure by 11 – 20 dB, followed by 5 cases of fair i.e. 21 – 30 dB A-B gap closure. Conclusion: Tympanoplasty using Fat from ear lobule has high success rate of 90% for tiny small perforations. It is an office procedure which is cost effective with minimum post operative morbidity. But it is an underused procedure. We should practice it more for the benefit of our patients. Further long term study with more number of patients and verities of graft materials are necessary to achieve detailed and accurate results.

Fully Implantable Active Middle Ear Implants After Subtotal Petrosectomy With Fat Obliteration: Preliminary Clinical Results.

In patients with chronic middle ear disease, especially after revision surgery for ventilation problems and mixed hearing loss, active middle ear implants may provide an alternative treatment option. The fully implantable active middle-ear implant (FI-AMEI) is designed for implantation in a ventilated mastoid with an intact posterior canal wall. Until now, there have been no reports on audiometric results after implantation of a FI-AMEI in a fat-obliterated cavity after subtotal petrosectomy (SPE). Retrospective case review. Tertiary referral center. Twelve patients were included after numerous previous tympanoplasty surgeries for severe mixed hearing loss and FI-AMEI implantation. In five patients, the FI-AMEI was implanted in a cavity, with fat obliteration, after SPE. Seven patients received FI-AMEI implantation after intact canal wall (ICW) surgery. Audiometric results (pure-tone audiometry, Freiburger monosyllables) are demonstrated for 12 patients after an observation period of 3 months. The improvement in monosyllable score was 40 to 85% for the 12 patients. Free-field-aided thresholds showed high heterogeneity. FI-AMEI implantation combined with SPE provides an alternative approach to hearing rehabilitation to non-FI-AMEI implantation. Studies with a high number of patients and long-term observation periods are necessary to statistically verify these results.

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.

Hearing outcome following ossicular reconstruction for incus defects using partial ossicular replacement prosthesis

Background: Situation of incus erosion is common while performing tympanoplasties for cases of chronic otitis media. As none of the available techniques is said to be gold standard, a cost effective and easily available partial ossicular replacement prosthesis is employed and the postoperative hearing outcome is presented.
 Objectives: To assess the hearing results of ossiculoplasty using partial ossicular replacement prosthesis (PORP) during tympanoplasty.
 Methodology: A descriptive cross-sectional study was carried out in a tertiary referral hospital of Nepal from June 2018 to September 2019. Thirty consecutive patients who underwent tympanoplasty for chronic otitis media (inactive/mucosal) with incudostapedial discontinuity were operated using polytetrafluroethylene partial ossicular replacement prosthesis without removing the incus. Pure tone averages, air-bone gap (ABG) and air conduction gain were calculated pre and post-operatively.
 Results: There was no extrusion of prosthesis. The post-operative air-bone gap less than 20 dB was achieved in 23 (77%) cases. All the patients had post-operative air-bone gap of ≤25 dB. There were no major complications.
 Conclusion: Polytetrafluroethylene partial ossicular replacement prosthesis is safe, reliable and efficient alternative for ossiculoplasty when the incus is found to have eroded during tympanoplasty surgery.

Evaluation of the perioperative effects of dexmedetomidine on tympanoplasty operations.

This randomized double-blind study aimed to evaluate the effects of dexmedetomidine on hemodynamic parameters and the quality of surgery and recovery criteria in tympanoplasty operations. A total of 75 patients 18-55years undergoing tympanoplasty, who were graded as American Society of Anesthesiologists physical status I-II, were randomly divided into three groups. Group 1 included patients receiving remifentanil alone, Group 2 included patients receiving dexmedetomidine + remifentanil and Group 3 included patients receiving dexmedetomidine + ½ remifentanil. Anesthesia was induced with propofol and cisatracurium. For maintenance of anesthesia, a mixture of 2-2.5% sevoflurane, 40-60% oxygen/air was used. The groups were compared in terms of hemodynamic parameters, surgical area, recovery criteria, modified Aldrete, pain scores, additional analgesic requirements and adverse effects. Mean arterial pressure and heart rate values of Group 1 were higher at the time of intubation, incision, spontaneous breathing and extubation compared to Group 2 and Group 3. Surgical field satisfaction was higher in Group 2 and Group 3 than Group 1. Spontaneous breathing, eye opening and verbal cooperation times were shorter in Group 3 compared to Group 2. Eye opening and verbal cooperation times were longer in Group 2 compared to Group 1. The 30-minute modified Aldrete scores was higher in Group 3 compared to Group 1. There was no difference between the groups in terms of postoperative pain and adverse effects. The use of dexmedetomidine during tympanoplasty operations may provide better hemodynamic control and surgical view, may provide faster recovery and may reduce remifentanil consumption.

Comparative Study of Hearing Results in Various Types of Tympanoplasties.

This study mainly focus on hearing loss pattern in CSOM patients undergoing tympanoplasty surgery or tympanomastoidectomy pre-operatively and analysis of the outcome of the surgery in terms of improvement in hearing (air-bone gap) after 3months of the surgery. All patients of age 15-65years reporting to ENT OPD with ear discharge and decreased hearing were screened with detailed history, clinical examination and microscopic examination.110 cases of tympanic membrane perforation who were fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy. Our study shows that postoperative air-bone gap closure is maximum for cortical mastoidectomy type I tympanoplasty (14.03dB), followed with cortical mastoidectomy with type II (12.2dB), Type I tympanoplasty (11dB), cortical mastoidectomy with type III (7.72dB). Procedures combined with modified radical mastoidectomy showed a very poor mean improvement in our study. It is very difficult to predict the results preoperatively because outcome will depend on extent of involvement of middle ear cleft by the disease process which can only be assessed intraoperatively.

Does Postauricular Incision Cause Auricula Protrusion After Tympanoplasty?

An ear surgery can be performed via transcanal, endaural, or postauricular approach according to the surgeon's desicion. The postauricular one is the most commonly performed approach. The objective of this study was to evaluate whether preferring postauricular approach during ear surgery cause auricular protrusion in over time. Thirty-six patients who underwent tympanoplasty operation with postauricular incision were included in this study. Any patient who was under 18 years of age, those with auricular deformity and patients who underwent tympanoplasty operation with mastoidectomy were excluded from this study. The distances from mastoid area to superior and mid-point of helix were measured preoperatively and 1 year postoperatively. A total of 36 patients' data were analyzed. There were 13 males and 23 females. The mean age was 28.2 ± years (18-59). The preoperative mean distance from mastoid area to superior point of helix was 15.03 ± 2.86 mm, whereas it was 17.92 ± 2.96 mm at mid-helix level. At postoperative 1 year, the same distances were measured 14.67 ± 3.12 mm and 17.25 ± 3.17 mm, respectively. There were no statistically significant differences between preoperative and postoperative measures. Although the structures that provide the stability of the auricle are cut during postauricular sulcus incision, long-term follow-up of patients did not show any protrusion of auricula.

Comparative Study between IV Dexmedetomidine versus IV Dexmedetomidine with Nalbuphine as an Adjuvant for Monitored Anesthesia Care in Tympanoplasty Surgeries

Comparative Study between IV Dexmedetomidine versus IV Dexmedetomidine with Nalbuphine as an Adjuvant for Monitored Anesthesia Care in Tympanoplasty Surgeries

Ketamine-Dexmedetomidine Combination for Monitored Anaesthesia Care in Tympanoplasty Surgery: An Observational Study

Introduction: Monitored Anaesthesia Care (MAC) has been widely used for patients undergoing middle ear surgeries. Previous studies have shown that the use of local anaesthesia has many advantages over general anaesthesia in performing ear surgeries. The use of Dexmedetomidine as a sole anaesthetic agent had many disadvantages owing to its insufficient sedative effect, increased recovery time and haemodynamic instability. Hence, using a combination of low dose ketamine with Dexmedetomidine can prove to be useful in middle ear surgeries. Aim: To evaluate the effects of Dexmedetomidine-Ketamine (DK) combination on the quality of sedation/analgesia and recovery profiles for MAC in tympanoplasty surgery. Materials and Methods: In this observational study, a total of 20 patients were included. All the demographic data- including, age, sex and American Society of Anesthesiologists (ASA) grade were recorded before the surgery. Before the surgery, all patients received 1 μg/kg dexmedetomidine over 15 minutes followed by infusion of 0.2-0.7 μg/kg/h to maintain 2 or 3 of modified observer’s assessment of analgesia and sedation score. Both the scores were checked every 10 minutes. Ketamine was infused at the rate of 10-15 mcg/kg/min, 10 minutes before the start of the procedure. The Heart Rate (HR), systolic and diastolic pressure, pain score and sedation score were monitored every 10 minutes until 120 minutes of the preoperative condition after the nerve block was used. Statistical analysis was performed using IBM SPSS Version 25.0 (IBM, New York, United States). Continuous data values were shown in the form of mean±standard deviation. To compare the mean difference between the groups, student’s t-test was used and p<0.05 was considered as statistically significant. Results: The mean age of the population was 39.45±12.66 years; among which 15 patients (75.0%) were females. Out of 20 patients, 12 (60.0%) were in the ASA-I and 8 (40.0%) were in the ASA-II grade. The result of the study showed not a single instance of complication. All the patients were haemodynamically stable and HR was also found to be constant in both pre and postoperative instances. The pain score was found to be around 2 even after 120 minutes after the surgery (2±0.93). No rescue analgesia was required in any of the patients and all the patients recovered within 3-5 minutes after the infusion was stopped. No postoperative nausea and vomiting instances were also reported. Conclusion: The present study showed that DK combination provides good haemodynamic stability, higher sedation score and lower pain score. In addition, this study also showed that for patients undergoing tympanoplasty surgery this is a safe and effective method of anaesthesia that provides good MAC.

Comparative study of dexmedetomidine versus midazolam in monitored anaesthesia care in tympanoplasty surgery

Background: Monitored anaesthesia care (MAC) has become increasingly used for middle ear surgeries. Midazolam is most commonly used for sedation in MAC; likewise, dexmedetomidine has gained popularity for intravenous sedation for the procedures to be done under MAC. The present study was undertaken to evaluate and compare the perioperativeeffects of inj. dexmedetomidine and midazolam with respect to sedation, analgesia and hemodynamic stability. Method: Study was approved by the Institutional Medical Ethics Committee and written informed consent was obtained from all patients participating in the study. Total 60 patients of ASA Grade I and II, aged 18 - 60 years, undergoing tympanoplasty surgery under local anaesthesia with 2% Lignocaine plus adrenaline 1:200000 and sedation with infusion of either dexmedetomidine or midazolam drug. Patients were divided in two groups of 30 patients in each group by chit block method. Group D received Dexmedetomidine 1 mcg/kg IV bolus over 10 min followed by continuous IV infusion at 0.5 mcg/kg/hr. Group M received midazolam 40 mcg/kg IV over 10 min followed by continuous IV infusion at 20 mcg/kg/hr. Results: Perioperatively, sedative effects of dexmedetomidine and midazolam were almost comparable, analgesic effects of dexmedetomidine was better than midazolam IV infusion. The significant reduction in haemodynamic variables was noted with dexmedetomidine (p=0.001) provided better hemodynamic stability than midazolam. Oxygen saturation and respiratory rate were maintained within normal limits in both the groups. 80% of surgeons in either group showed significant satisfaction but the difference was not statistically significant between two groups. Conclusion: Dexmedetomidine is a safe agent as sedative in patients undergoing tympanoplasty surgery under local anaesthesia with MAC.

Administration of Clonidin as Adjuvant to Infiltration Anaesthesia in Tympanoplasty Surgery

Administration of Clonidin as Adjuvant to Infiltration Anaesthesia in Tympanoplasty Surgery

A comparative study of using temporalis fascia autograft and dehydrated temporal fascia homograft in tympanoplasty

<p class="abstract"><strong>Background:</strong> The objective of the present study was to compare the results of tympanoplasty operations performed using autograft temporalis fascia with those of dehydrated temporalis fascia homograft.</p><p class="abstract"><strong>Methods:</strong> This prospective study was conducted in the department of ENT of Pacific Medical College and Hospital, Udaipur in duration from February 2014 to January 2015. The study included 90 patients of chronic suppurative otitis media with dry, central perforation of tympanic membrane. The patients were divided into two groups with 45 members in each group. In group A, temporalis fascia autograft was used and in group B, dehydrated temporalis fascia homograft was used for tympanoplasty. Results were evaluated in terms of graft uptake rate and hearing improvement. </p><p class="abstract"><strong>Results:</strong> There were 50 male and 40 female patients in the study. Most of the patients (43.33%) were of the age group 21-30 years, followed by age group 31-40 years (24.44%). Post-operatively, 95.55% patients in group A and 91.11% patients in group B showed successful graft uptake. Mean preoperative AB gap in group A patients was 31.46±6.78 dB which was reduced to 13.01±5.61 dB postoperatively. Similarly, in group B patients, AB gap was reduced from 29.81±5.99 to 12.92±6.01 dB postoperatively. No statistically significant difference was observed between groups while comparing pre and postoperative AB gap.</p><p class="abstract"><strong>Conclusions:</strong> The results of tympanoplasty done by using either homograft or autograft were the same so dehydrated temporalis fascia homograft can be used as an alternative graft material with the same success rate wherever possible with the advantage of reduction in duration of surgery.</p>

Numerical modelling and vibration analysis of human middle ear for application in sound conduction reconstruction

In this paper, we introduce a new numerical approach for estimating the hearing restoration eect prior to the tympanoplasty operation using the nite element harmonic vibration analysis. This kind of approach makes it possible to propose a new medical treatment for the recovery of conductive or cochlear hearing loss. First of all, precise geometric models of the middle ear, including healthy type model and tympanoplasty type models, are constructed on the basis of the computerized tomography (CT) scanning data. Then, frequency response characteristics of the stapes displacement in sound conduction are claried using the three-dimensional nite element harmonic vibration analysis. Based on the investigation results, we propose that the hearing restoration eect can be estimated by a comparison of the dierences in the stapes displacement between the reconstruction model and the healthy subject.

A retrospective study on middle ear risk indices in analysing the postoperative outcome following tympanoplasty

<p class="abstract"><strong>Background:</strong> Otitis media is an important and a highly prevalent disease of the middle ear and poses serious health problem worldwide especially in developing countries where large percentage of the population lack specialized medical care. A normally functioning eustachian tube is an equally essential physiologic requirement for a healthy middle ear and normal hearing. In this study we have used the middle ear risk index (MERI) developed by Kartush which generates a numeric indicator of the severity of the middle ear disease to stratify patient groups according to the severity of the disease and to evaluate the efficiency of MERI score in predicting the outcome of tympanoplasty.</p><p class="abstract"><strong>Methods:</strong> Patients who came and got operated for tympanoplasty to the ENT Department in Konaseema Institute of Medical Sciences and RF, Amalapuram during the study period of February 2017 to February 2018. </p><p class="abstract"><strong>Results:</strong> In this study graft was accepted in 22 patients (88%) and rejected in 3 (12%) patients. In patients in the mild MERI risk group n=22, graft was accepted in 21 (95%) patients and rejected in 1 patient (5%). Patient had a residual perforation. In patients in the moderate MERI risk group n=2, graft was accepted in 1 (50%) patients and rejected in 1 patient (50%).In severe risk group none of the grafts were accepted (100%).</p><p><strong>Conclusions:</strong> MERI index is in fact a very useful and honest predictor of the graft uptake and audiological gain in patients undergoing tympanoplasty surgeries for CSOM. Lower the MERI index better the outcome. Positive Belluci criteria were also found to be inversely associated with the graft uptake.</p>

Evaluation of middle ear risk index in patients undergoing tympanoplasty.

Tympanoplasty is a standard surgical procedure for the treatment of chronic otitis media. In this study, we aimed to determine the effect of the predictive factors of middle ear risk index (MERI) in patients undergoing tympanoplasty. A total of 200 patients who underwent tympanoplasty surgery from 2008 to 2018 at Khalili hospital in Shiraz were evaluated. In this study, variables such as age, sex, systemic diseases (diabetes mellitus, hypertension), location and size of tympanic membrane perforation (TMP), health of the opposite ear, dryness duration of the ear, presence or absence of myringosclerosis during surgery, type of operation and the risk of MERI were evaluated. The success rate for a 6-month follow-up of patients was 88%. Results showed that there was a significant difference between the MERI scores and the three types of operation of intact canal wall (ICW), canal wall down (CWD) and non mastoidectomy (P < 0.001). The longer the dryness duration of the ear, the MERI score was lower. When MERI score is low, the patient doesn't need mastoidectomy. Also, the worse the opposite ear, the higher the MERI score was. The highest MERI score was in patients undergoing CWD, and the lowest MERI score was in patients undergoing simple tympanoplasty. MERI score is a useful tool for predicting the success rate of tympanoplasty and helps the surgeon planning the type of tympanoplasty.

Collagen Allografts Compared With Autologous Tissue in Tympanoplasty.

There are no direct comparisons between the success of collagen allografts versus traditional autografts for tympanic membrane (TM) repair. We sought to compare success rates in a large series of patients undergoing tympanoplasty using collagen allografts versus autologous tissues. Retrospective review. Academic medical center. Single institution retrospective chart review was performed for adult subjects with TM perforation undergoing tympanoplasty. Demographic, clinical, and surgical data were collected. Statistical analysis was completed using Rstudio. Each factor was examined to assess effect on graft success rate using logistic regression. Two hundred sixty-five surgeries met criteria with four main grafting materials or combinations thereof. The overall graft success rate was 81.1% with failure rate of 18.9%. There was no significant association between failure rates and: age, sex, perforation cause, size, and location, primary or revision status, middle ear status (wet or dry), concomitant procedures (mastoidectomy or ossiculoplasty), presence of active cholesteatoma, or surgical technique. Although not statistically significant, the odds of success for perichondrium + cartilage were 7.5 times higher than collagen allografts (p = 0.07, 95% confidence interval [CI] = 0.81-69.6). The odds of success for the postauricular (odds ratio [OR] = 6.4) and transcanal approaches (OR = 24.8) were significantly greater than for endaural (p = 0.007 and p = 0.008, respectively). In tympanoplasty surgeries performed on patients with TM perforation, we found no statistically significant difference in graft failure rates between collagen allograft and other grafting materials or combinations, though the higher odds ratio of success with cartilage + perichondrium may be clinically relevant.

Eustachian tube functional assessment among patients with CSOM undergoing tympanoplasty surgery

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Pre-operative test of eustachian tube (ET) function is important for achieving a satisfactory result of tympanoplasty for CSOM patients. The saccharin test and methylene blue test seems to provide adequate information of the mucociliary function and patency of the ET. The aim was to study the ventilatory and mucociliary function of Eustachian tube in patients with chronic suppurative otitis media planned for tympanoplasty surgery and to assess the success rate of tympanoplasty in relation to the Eustachian tube function&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective longitudinal study was conducted for a period of one year. Patients aged more than 15 years with features of chronic suppurative otitis media of either tubotympanic type or atticoantral type were included in the study. The total number of study subjects included in our study was 82 patients with CSOM. The ventilatory and the mucociliary functions of the auditory tube were assessed preoperatively using saccharin test and methylene blue test. All patients with CSOM underwent tympanoplasty surgery and the outcome of the surgery was assessed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The overall success rate of tympanoplasty surgery was 76.8%. It was observed in our study that the success rate of tympanoplasty was higher among patients with normal eustachian tube function.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Preoperative evaluation of eustachian tube function is mandatory for all the patients planned for tympanoplasty. Preoperative and intraoperative corrective measures should be taken in patients with partial and absent tubal function to improve the success rate of tympanoplasty surgeries.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Outcomes of Endoscopic Assisted Versus Microscopic Assisted Type1 Tympanoplasty for Inactive Chronic Otitis Media

Background and objectives: The objectives of this study is to assess the outcomes of the endoscope as compared to the microscope in type 1 tympanoplasty surgery for cases with inactive chronic otitis media. Methods: Prospective comparative study was conducted from October 2016 to October 2017, forty patients underwent myringoplasty, twenty were endoscope assisted and twenty were microscope assisted. Results of surgery were compared at the end of six months post-operation. Results: In the endoscope group 85% while in the microscope group 90% of patients had a successful outcome. Average time taken in microscopic myringoplasty was 103.75 minutes range (75 -150 minutes) while time taken in the endoscopic myringoplasty group was 82.25 minutes range (60 -120 minutes). Average hearing gain was 12.25 dB for microscope assisted group and 11 dB for endoscope assisted group. Conclusions: The surgical result of endoscope assisted myringoplasty was similar to the microscope assisted myringoplasty although the graft taken and postoperative hearing gain in microscopic group was better than endoscopic group, but the operation dura-tion in endoscope group was shorter.

Complications after round window vibroplasty.

To evaluate the complication rate in adult subjects with open cavities that were implanted with the Vibrant Soundbridge implant, using the round window (RW) vibroplasty procedure. From2009 to 2014, 21 adult subjects with mixed hearing loss, all with sequel from open tympanoplasty surgery, underwent RW vibroplasty (RW-VPL). Surgical complications were recorded and a standard minimal approach was used as a basis for all the cases that needed revision. The mean follow-up was 42months (range 12-76). Complications occurred in nearly half of the cases and included: cable extrusion (23.8%), hardware failure (14.3%), profound hearing loss (9.5%), and inadequate RW coupling (9.5%). A minimal endaural approach (MEA) was used in the majority of the cases (86.7%), while the extended endaural approach was adopted for those patients requiring explantation with or without replacement (14.3%). RW-VPL can be considered a possible option for the rehabilitation of auditory impairment derived from an open tympanoplasty procedure due to cholesteatoma. The procedure may lead to minor/major complications that may require a surgical revision. By adopting an MEA, it has been possible to manage all the situations in which functionality of the device is worth being preserved.

Comparison of Dexmedetomidine with Pentazocine and Promethazine in Tympanoplasty Surgeries under Monitored Anaesthesia Care: A Prospective, Randomized, Double Blind Study

Comparison of Dexmedetomidine with Pentazocine and Promethazine in Tympanoplasty Surgeries under Monitored Anaesthesia Care: A Prospective, Randomized, Double Blind Study