PurposeTo compare the outcomes of endoscopic and microscopic tympanoplasty (TPL) types I-III in pediatric patients.MethodsA retrospective case-control study was conducted on 70 TPL cases in 58 pediatric patients at Inselspital, Bern University Hospital, Switzerland, from June 2017 to December 2023. Data on hearing function, graft intake, residual disease, operating time and complications were collected.ResultsWe observed mean postoperative air-bone gap (ABG) of 16.83 dB using the endoscopic and 19.37 dB for the microscopic techniques, as well as a higher graft intake rate (91%) for the endoscopic compared to the microscopic group (80%), although these differences did not reach statistical significance. No residual cholesteatoma was found in the endoscopic group, while the microscopic group had a significantly higher incidence of residual disease (42%; p = .03). The mean operative time was shorter in the endoscopic group (87 min vs. 113 min; p < .01). Postoperative complications were lower in the endoscopic group compared to a 14% incidence in the microscopic group.ConclusionEndoscopic tympanoplasty in pediatric patients achieves similar audiological outcomes and graft intake rates compared to the microscopic approach while offering significant advantages, including reduced operation times and lower complication rates. This minimally invasive approach is highly effective especially regarding cholesteatoma resection and provides excellent functional and structural outcomes.

The objective of the study is to evaluate the outcomes of surgical management options for cholesteatoma using a national database. Database analysis of the Pediatric Health Information System database to identify children undergoing surgical intervention for cholesteatoma from October 2015 to December 2022. Patients were categorized by initial surgical modality: tympanoplasty (TM), tympanoplasty with canal wall-up tympanomastoidectomy (TM-CWU), and tympanoplasty with canal wall-down tympanomastoidectomy (TM-CWD). Group comparisons were done on number of surgical revisions and number of patients identified with recommendations for hearing aids. A total of 6304 patients were identified in the database who underwent surgery for cholesteatoma. Of these children, 3405 underwent TM (54.0%), 3116 underwent TM-CWU (49.4%), and 825 underwent TM-CWD (8.2%). The estimated difference in mean number of procedures was significantly higher in the TM-CWU group compared to TM-CWD (-0.34, 95% confidence interval [CI] -0.406,-0.279, P < .0001) and the TM group (9.352, 95% CI 0.315, 0.390, P < .0001). The rate of significant hearing loss necessitating hearing aids was significantly lower in the TM group, but there was no difference between the TM-CWU and TM-CWD groups (1.2%, P < .03, 1.9% vs 2.7%, P = .13). There was no difference in the number of speech delays/therapy diagnoses between TM and TM-CWU or TM-CWU and TM-CWD (3.5%vs 4.4% P = .07, 4.4% vs 5.2%., P = .38). TM and TM-CWD had lower total surgical procedures than the TM-CWU group, and the TM group had a lesser rate of recommendation for hearing aids. The difference between number of procedures is likely due to the complexity of the disease; for instance, TM was likely chosen for small, less severe disease cases, whereas TM-CWD was chosen as more definitive treatment in aggressive cases. TM-CWD is associated with a lower rate of recidivism and recurrence, which also likely contributed to the lower number of procedures.

Artificial intelligence and ChatGPT: An otolaryngology patient's ally or foe?

CSOM patients are most commonly managed surgically by type I tympanoplasty using either cartilage shield technique or underlay grafting technique. In our study, we have compared the graft uptake and hearing results of type I tympanoplasty using temporalis fascia and cartilage shield, and also reviewed the literature regarding the results of these two methods. 160 patients aged between 15 and 60 years were randomized into two groups of 80 patients each, with odd numbers subjected to conchal or tragal cartilage shield grafting in group I, while in group II with even numbers, the patients underwent temporalis fascia grafting by underlay technique. Three months post-surgery, the graft uptake was seen in 76 patients (95%) in the cartilage shield group as compared to 58 patients (72.5%) in the temporalis fascia group, which was statistically significant between the two groups [Fisher's exact value = 0.000]. The uptake rate was much higher in cartilage shield graft as compared to fascia graft even in complicated cases like revision tympanoplasty (TP), discharging ear, subtotal perforation and retracted/adhered TP. Also, the hearing improvement in fascia and cartilage shield group was not statistically significant comparing pre- and post-operative patients, indicating that there was not much difference in audiological outcomes between the two groups. We advocate the use of cartilage shield graft as a substitute for fascia graft in all feasible cases as well as in complicated situations to improve the success rate of type I tympanoplasty, without compromising on the hearing improvement, as seen in our study. The online version contains supplementary material available at 10.1007/s12070-022-03175-1.

Role of antrotomy in tympanoplasty - IJASHNB- Print ISSN No: - 2581-5210 Online ISSN No:- 2581-5229 Article DOI No:- 10.18231/2581-5229.2018.0021, IP Indian Journal of Anatomy and Surgery of Head, Neck and Brain-IP Indian J Anat Surg Head Neck Brain

Background: Type 1 tympanoplasty or myringoplasty is the most frequently performed procedure in the field of otology. Type 1 tympanoplasty is a surgical procedure to repair and only involves the restoration of the perforated tympanic membrane. There are three most accepted methods often used universally, namely underlay, overlay, and interlay. The interlay method is a relatively new method developed in 1992 for closing tympanic membrane perforation. This method has a high success rate of 96%. Objective: To report the success of type 1 tympanoplasty with an interlay method to close large central tympanic membrane perforations at Margono Soekarjo District Hospital. Case Report: Reporting 3 cases of chronic tubotympanic suppurative otitis media with large central tympanic membrane perforation which were repaired by type 1 tympanoplasty using interlay method. Clinical Question: Does interlay method type 1 tympanoplasty performed on large central tympanic membrane perforation provide better result compared with other methods of type 1 tympanoplasty? Review Method: Studying the evidence-based literatures on type 1 tympanoplasty interlay methods through Cochrane, Pubmed, and Google Scholar databases. Based on the inclusion and exclusion criteria, three journals were relevant with the reported cases. Result: All three journals stated that interlay method type 1 tympanoplasty had high success rate in terms of closing the tympanic membrane perforation and diminishing air-bone gap. Conclusion: Type 1 Tympanoplasty interlay method could be used as an alternative for the closure of a large central tympanic membrane perforation.Keywords: Chronic Tubotympanic Suppurative Otitis Media, large central tympanic membrane perforation, interlay tympanoplasty ABSTRAK Latar belakang: Timpanoplasti tipe 1 atau miringoplasti merupakan prosedur di bidang otologi yang paling sering dilakukan. Timpanoplasti tipe 1 merupakan metode pembedahan yang bertujuan untuk memperbaiki, dan terbatas hanya di membran timpani. Terdapat tiga metode yang paling diterima dan sering digunakan secara universal, yaitu underlay, overlay, dan interlay. Metode interlay merupakan metode penambalan perforasi membran timpani yang relatif baru, dikembangkan pada tahun 1992. Metode ini mempunyai keberhasilan yang tinggi yaitu mencapai 96%. Tujuan: Melaporkan keberhasilan timpanoplasti tipe 1 dengan metode interlay untuk penutupan perforasi membran timpani sentral besar di RSUD Margono Soekarjo. Laporan kasus: Dilaporkan 3 kasus otitis media supuratif kronik tipe tubotimpani dengan perforasi sentral besar, yang dilakukan timpanoplasti tipe 1 dengan metode interlay. Pertanyaan klinis: Apakah metode interlay timpanoplasti tipe 1 yang dilakukan pada perforasi membran timpani yang besar, dapat memberikan hasil yang lebih baik daripada metode lain timpanoplasti tipe 1? Telaah literatur: Telaah berbasis bukti mengenai timpanoplasti tipe 1 metode interlay melalui database Cochrane, Pubmed, dan Google Scholar. Berdasarkan kriteria inklusi dan ekslusi didapatkan tiga jurnal yang relevan dengan kasus yang dilaporkan. Hasil: Ketiga jurnal tersebut menyatakan bahwa timpanoplasti tipe 1 metode interlay mempunyai angka keberhasilan yang tinggi dalam hal penutupan perforasi membran timpani maupun mengurangi air-bone gap. Kesimpulan: Timpanoplasti tipe 1 metode interlay dapat digunakan sebagai alternatif untuk penutupan perforasi membran timpani sentral yang besar

Comparison of the Effects of Dexmedetomidine and Remifentanyl on Haemodynamics, Awakening and Recovery in Tympanoplasty and Tympanomasteidectomy

Introduction: Tympanoplasty is one of the commonly performed surgical treatments for chronic otitis media (COM). Graft used in tympanoplasty is temporalis fascia which is placed at the perforation site but usually without any securing agent like sutures, etc., This can lead to various problems such as medialization or lateralization of the graft (graft displacement) or anterior blunting, which affects the hearing outcome of tympanoplasty. Aim: The aim of this study is to study the role of in house autologous tissue glue in tympanoplasty as a graft-securing agent. Materials and Methods: One hundred cases of COM were divided into two groups of fifty cases each. In Group I, tympanoplasty was done without using tissue glue, whereas in Group II, tympanoplasty was done using in house autologous tissue glue as the graft securing agent, and the results were analyzed. Results: Graft uptake rate in Group I was 84% and in Group II was 92%. Five cases of anterior blunting and three cases of graft medialization were recorded in Group I, whereas there was only one case of anterior blunting in Group II with no graft displacement. Conclusion: Autologous in house tissue glue can be used as a graft-securing agent in tympanoplasty.

Introduction: 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 and Objectives: To study the efficiency of MERI in predicting the outcome of tympanoplasty in all age-groups. Materials and Methods: A prospective study was carried out in the department of Ear Nose and Throat (ENT), Banaras Hindu University (BHU), Varanasi, where all cases of chronic suppurative otitis media in the age-group of 8–40 years were included from September, 2017 to December, 2018. Total 74 patients with unilateral or bilateral perforation of tympanic membrane were included and these were followed-up for 4 months after surgery. Results: Maximum cases fell under MERI 1-3 (mild disease) and these patients had the best prognosis after tympanoplasty. Patients with unilateral perforation had better success rate as compared to patients with bilateral perforation. 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.

Tympanoplasty

Aim: This study aims to know the correlation between the preoperative gel foam patch test with the postoperative hearing outcome. Objectives: The objective is to correlate and compare the air-bone gap (ABG) and mean hearing thresholds obtained at frequencies 500 Hz, 1 KHz, 2 KHz, and 4 KHz through audiological evaluation preoperatively, immediately after gelfoam application and 2 months postoperatively (Type I tympanoplasty). Materials and Methods: A total of 124 cases with a mean age of 37 years with a history of chronic otitis media (COM, mucosal type) having medium to large size of central perforation of the tympanic membrane with pure conductive hearing loss participated in this study. Cases were subjected to routine investigations along with a battery of otological investigations. Further, pure-tone audiometric evaluation was performed before gelfoam patch application, immediately after gelfoam patch application and postoperatively after 2 months and the outcomes were compared. Results: Across all four frequencies, ABG was improved and showed a highly significant difference between preoperative mean findings in comparison to patch and postoperative findings. In this study, a strong positive correlation and reliability between patch test hearing thresholds and postoperative hearing thresholds are observed. Comparing preoperative hearing thresholds and postoperative hearing thresholds with student t-test thresholds improved by approx 17 dB hearing loss (17.50645). Conclusion: Hence, this study shows preoperative gel foam patch test in cases of pure conductive hearing loss is reliable in predicting the postoperative hearing outcome. Furthermore helps in convincing and counseling the patients.

Expected Findings and Complications After Tympanoplasty and Mastoidectomy

One- versus two-session treatment in type IV tympanoplasty

Use of Biodesign® Otologic Graft in Tympanoplasty

Aims and Objective: The present study was undertaken to compare the results of various autogenous tissues temporalis fascia, tragal perichondrium, and vein as graft materials for the Type 1 tympanoplasty. Materials and Methods: A total of 120 cases with large, subtotal, and total perforation were considered in the study. Of the 120 cases, temporalis fascia graft was used in 60 cases (Group-I), tragal perichondrium graft in 40 cases (Group-II), and vein graft in 20 cases (Group-III). The results were evaluated in the form of rate of graft success, hearing gain, and mean residual air-bone gap with respect to the graft materials. Results and Observation: A nonsignificant association was observed between the groups, that is, temporalis fascia (Group-I), tragal perichondrium (Group-II), and venous graft (Group-III), and the graft uptake (P = 0.96 > 0.05) and air-bone closure (χ2 = 2.908, P = 0.059 > 0.05). Conclusion: The graft take up rate and hearing improvement are similar for the different graft materials used. Size of the perforation does not significantly influence the success rate of tympanoplasty as per our study. Normal translucent appearance of neotympanum in the postoperative period was seen only with temporalis fascia and venous graft, while in tragal perichondrial, the neotympanum was whitish, thicker, and translucent to opaque.

Different variations in methods and materials used in tympanoplasty

Aims and Objectives: To compare the results of tympanoplasty alone and tympanoplasty with cortical mastoidectomy in chronic suppurative otitis media (CSOM) patients in terms of graft uptake, perforation closureand improvement in hearing. Method: The study enrolling total 60 patients of either sex, age between 15 to > 45 years and were divided in two equal groups. Group A operated by type 1 tympanoplasty alone and group B operated by type 1 tympanoplasty with cortical mastoidectomy.The graft uptake rate and hearing improvement was compared between these two groups based on follow up and repeat audiogram on 12 th postoperative week. Results: In the presentstudy, majority of patients were in the age group of 26-35 years with female predominant by male to female ratio of 1: 3.6.Graft uptake success rate were more in group B (93.3 %)than in group A(90 %).Three months after the surgery, 22 (73.33%) patients showed hearing improvement in group A and 25 (83.3%) patients in group B which was not statistically significant. Conclusion: The graft uptake and hearing improvement were clinically better in group B but difference in two groups was statistically insignificant. Combining cortical mastoidectomy with tympanoplasty does not give additional benefit in terms of hearing improvement or graft uptake but ABC closure after 3 months of surgery was significantly better in group B.

Outcomes of type I tympanoplasty using a cartilage shield graft in patients with poor prognostic factors

SUMMARYCartilage is one of the most preferable grafts for tympanoplasty (TPL). The anatomical and audiological results and take rates of perichondrium attached cartilage island graft in tympanoplasty (PACIT) are presented herein. One hundred ninety four ears of 191 patients (108 male, 83 female) were evaluated retrospectively in terms of the type of surgery, graft take rate and hearing results. Type I, II, and III TPL were performed in 127 (65.46%), 45 (23.20%), and 22 (11.34%) ears, respectively. The overall mean preoperative pure tone average-air bone gaps (PTA-ABGs) for TPL types were 33.74 ± 9.60, 52.58 ± 9.07, and 56.58 ± 10.27 dB HL, respectively; postoperative mean values for TPL groups were 18.55 ± 9.25, 31.21 ± 4.36, and 44.84 ± 12.45 dB HL. Postoperative hearing results showed an improvement (≥ 10 dB) in 76.81% of ears with a mean gain of 20 dB HL (range 10-40 dB). However, 19.07% of ears showed no change (< 10, ≥ 0 dB) in hearing, and hearing worsened in 4.12% of ears (< 0 dB) postoperatively. Overall, graft take was 91.24% at least 13 months (mean 68.64) after surgery with a graft failure rate of 8.76%. Graft take was successful in TPL groups. Postoperative PTA-ABG results demonstrated significant improvement. The long-term eligibility of perichondrium attached cartilage island graft in TPL is emphasised with this study.

Cartilage versus the rest in Type I Tympanoplasty – who wins?