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Introduction: Chronic otitis media with cholesteatoma is a locally destructive middle ear infection with bone erosive properties which can lead to fistula if erodes labyrinth. Materials and Methods: A prospective observational study was conducted at tertiary health care centre with a total of 12 patients who presented with complaints of otorrhoea, hearing loss and vertigo. Such patients were evaluated clinic audiologically and radiologically as a pre op assessment. Post-surgery audiological assessment was done. Results: Hearing preservation was seen in 91.7% patients and none of the patients had iatrogenic sensorineural hearing loss. Conclusion: Complete removal of the cholesteatoma is beneficial and does not lead to any iatrogenic SNHL when performed meticulously. A newer way of diagnosing membranous labyrinthine breach utilizing Magnetic Resonance Imaging T2 Diffusion Weighted (MRI- T2 DW) sequence can be implemented. [ABSTRACT FROM AUTHOR]

The present study aimed to evaluate the pneumatization status of the mastoid air cells in general with the depth and status of mastoid antrum in particular, in patients of chronic otitis media (COM). This is an observational cross-sectional study in sample size of 60 participants with large, subtotal perforation and posterosuperior retraction pocket (PSRP). Mean age with large central and subtotal perforation combined was 35.78 years, compared to 32.13 years in PSRP. Granulations seen in antrum in 71.6% and cholesteatoma observed in 15%. Mean depth of the mastoid antrum was 17.27 mm. A well pneumatized mastoid in 21.6%, diploic 28.3% and sclerotic in 50% was noted in this study. Chronic otitis media affects temporal bone pneumatization, particularly the mastoid antrum. Our findings indicate that the depth of the mastoid antrum is slightly greater in cholesteatoma cases due to bone erosion. As early intervention enhances postoperative quality of life by preserving or restoring auditory function, understanding the mastoid pneumatization and antrum depth is crucial for managing chronic otitis media effectively. [ABSTRACT FROM AUTHOR]

To compare the depth of mastoid antrum on High Resolution Computed Tomography and per operatively in cases undergoing mastoidectomy. This prospective observational study was done in a tertiary care Army Hospital with 35 patients meriting cortical mastoidectomy surgery. The patients underwent HRCT of temporal bone as a routine pre-operative work up, where depth of mastoid antrum was measured from dome of lateral semicircular canal to outer cortex of temporal bone. Depth was also recorded per-operatively with the help of measuring scale. Measurements were correlated and data was analysed statistically. There were 12 male patients and 23 females. 6 patients were < 3 years of age and 29 above. Study included 29 cases of Chronic Otitis Media and 6 of Bilateral Congenital Sensorineural Hearing Loss. Mean depth of mastoid antrum was 1.625 cm ± 0.228 on HRCT, and 1.651 cm ± 0.245 per-operatively. Depths of mastoid antrum on HRCT and per operatively amongst paediatrics as well as adult cases were comparable, but were more than the standard depth of 1 cm in 5 (82.3%) paediatrics cases and ˃1.5 cm in 24 (82.9%) adult patients. In absence of Koerner's Septum, mean HRCT depth was 1.60 cm ± SD 0.23 and per operatively was 1.63 cm ± SD 0.21; whereas in its presence mean HRCT depth was 1.84 cm ± SD 0.069 and per-operatively was 1.85 cm ± SD 0.42. Significant difference in depth was noted between adults and children, and between the cases with or without Koerner's Septum. However, difference in depth was not significant when compared between different genders, laterality of disease or disease pathology. [ABSTRACT FROM AUTHOR]

Mastoid surgeries are surgical procedures, wherein surgical failures are prevalent due to the fundamental complexities involved, especially in the understanding of microscopy and pathophysiology of the disease. A revision mastoidectomy is an utmost, a post-procedure decision, wherein the patient continues to exhibit signs and symptoms that are concerning. This is proved by a prospective, cross-sectional research which was conducted upon a group of patients who were referred to a tertiary health care centre. This selection of twenty-three (23) patients who underwent mastoidectomy prior to their participation in this research, were exhibiting signs of recurrent diseases. The observations of trends seen in revision mastoidectomy are detailed and inferences gleaned from it. These trends and observations direct us towards the understanding that the majority of failure of previous mastoidectomy was due to persistent diseased air cells and recurrent or residual cholesteatoma. This is further corroborated by the trends observed from exhausting literature readings of previous similar studies. Revision mastoid surgeries are an important follow-up process, after the mastoidectomy, if the patients continue to exhibit diseased states. [ABSTRACT FROM AUTHOR]

To study the Impact of Otoendoscopy at the end of apparent microscopic clearance of disease during primary Cholesteatoma surgery in detecting the residual cholesteatoma. A prospective, interventional, non randomized and non comparative study was conducted at the ESIC Medical College and PGIMSR. All patients of chronic otitis media of squamosal type undergoing modified radical mastoidectomy were included in the study. Otoendoscopy was performed after apparent clearance of cholesteatoma under microscope. If any residual cholesteatoma detected during otoendocsopy was recorded. Total of 63 cases were included in the study. Residual cholesteatoma was seen in 14% of the cases. Commonest site of residual cholesteatoma was sinus tympani. Otoendoscopy helps in visualizing the deep recesses of the middle ear cleft for residual cholesteatoma after apparent clearance under the operating microscope. It also helps in clearing the cholesteatoma from these deep recesses there by it helps in reducing the recurrence rate of cholesteatoma. [ABSTRACT FROM AUTHOR]

Pediatric cholesteatomas (PC) have multifactorial aetiology, spread aggressively and there are high chances of residual/ recurrent disease after treatment. The surgical technique to manage this entity has been debatable. This study was done to (i) enumerate the presentation of PC and the surgical techniques adopted (ii) analyse the outcomes viz., residual/ recurrence rates and hearing results. A cross sectional record based study was done on 618 cases of PC operated between 1983 and 2015, at a centre dedicated to otology and lateral skull base surgery. The data which was maintained on the basis of clinical and peri- operative findings was analysed. Otorrhea (59.2%) and hearing loss (54.2%) were the common symptoms. The surgeries done were: canal wall up (CWU) (44.3%), canal wall down (CWD) (41.1%), modified bondy's mastoidectomy (5.7%), radical mastoidectomy (4.9%), trans canal excision (1.8%) and subtotal petrosectomy (2.3%). The residual and recurrence rates were 12.6% and 7.9% respectively. A significant difference between the pre and post operative hearing was observed. The mean improvement in air bone gap was 7.7db. Residual/ recurrent disease were higher in CWU as compared to CWD group. The surgery should be individualised so that the patient remains disease free. [ABSTRACT FROM AUTHOR]

Ossicular destruction is a common phenomenon in chronic otitis media due to an imbalance between osteoblasts and osteoclasts. Computed tomography helps us in the assessment of ossicular status, extent of pneumatization, and early identification of complications. This study aims to check the diagnostic accuracy of computed tomography temporal bone for the detection of ossicular erosion in comparison with the surgical findings taken as a gold standard. The use of this investigation as an adjunct can prove to be helpful in planning mastoid exploration as well as a primary reconstruction surgery especially in mucosal and early squamosal diseases. It's a cross-sectional validation study done on 50 patients with chronic otitis media (both mucosal and squamous type) from July 2022 to November 2023. Patients underwent CT scanning of temporal bone and ossicular status was reported by the radiologist. Later on, mastoid surgery was carried out and per operative findings were documented. 2 × 2 tables were formed and diagnostic accuracy of CT temporal bone was checked in terms of sensitivity, specificity, negative predictive value, and positive predictive value. The results revealed that CT temporal bone has a high diagnostic accuracy with a sensitivity of 92.5% and specificity of 100% for malleus (p value < 0.001). For incus and stapes, sensitivity came out to be 93.5% and 76% respectively and specificity values were 94.7% and 100% (p value < 0.001 for all) giving a verdict that the pre-operative use of this radiological investigation should be encouraged by otologists. [ABSTRACT FROM AUTHOR]

To study the surgical result and efficacy of different methods of mastoid obliteration with cavity care. This prospective study included 60 patients who had cholesteatoma, conducted in the Department of Ear Nose and Throat (ENT), Institute of Medical Sciences, Banaras Hindu University, Varanasi from July 2015 to July 2017. The mastoid cavity was obliterated with either muscle flap/bone dust/hydroxyapatite. detailed history otoscopic examination was done pre-operatively and follow up were recorded at 1 month and 3 months in postoperative period. 60 patients were included, who underwent canal wall down mastoid surgery. each group muscle flap (group 1), bone dust (group 2) and hydroxyapatite (group 3) included 20 patients, age group 31–40 year with its maximum incidence of 43.3%, Preop PTA value were almost equal in all group but on comparison at 1 month in postoperative period significant improvement was present in group 1 versus 2(0.021) and group 2 versus 3(0.003) but not in group 1 versus 3. Although at 3 month there were significant improvement was present in all groups. The incidence of pain, discharge, giddiness and wax formation were markedly reduced and healing of cavities was early and better in obliterated cavities done by muscle flap and bone dust material as compared to hydroxyapatite cavities, at the end of 3 months. outcome and quality of life was better and almost equal in muscle flap and bone dust material group as compared to hydroxyapatite group. [ABSTRACT FROM AUTHOR]

Chronic Otitis Media (COM) with complications is a common clinical entity in Otorhinolaryngology, but advances in antibiotics and surgical techniques have reduced complication rates and mortality. Management warrants surgical disease clearance, the choice of surgical approach of which may vary. Endaural approach is a less commonly performed approach in view of its complexity and surgical expertise. This case report presents a 13-year-old female with COM–squamous active type with cerebellar abscess, managed with Lempert's endaural mastoidectomy. The patient presented with long-standing left sided purulent ear discharge, ear pain, headache, and vomiting. Diagnosis included bilateral COM–squamous active type with left cerebellar abscess, status post suboccipital craniotomy. Endaural mastoidectomy was performed to circumvent the pseudomeningocoele and achieve disease clearance. Postoperative follow-up showed well-healed scars and no evidence of disease recurrence. Chronic Otitis Media with complications requires surgical management to prevent disease progression and related complications. Surgical approaches for disease clearance include post aural and endaural techniques. Lempert's endaural approach provided a superior view of the middle ear and mastoid, facilitating disease clearance and simplifying postoperative care with enhanced cosmesis. Although endaural approach demands surgical expertise, it can be a viable option for complicated cases. In this case, Lempert's endaural canal wall down mastoidectomy effectively managed COM–squamous active type with cerebellar abscess, offering a clear view of the disease epicenter with limited bone removal. The endaural approach, in the hands of an experienced surgeon, can be a feasible alternative for surgical clearance in complicated COM cases, providing favorable outcomes with superior visibility and cosmesis. [ABSTRACT FROM AUTHOR]

Aim: The surgical success rate of tympanoplasty appears to be influenced by a number of variables. Eustachian tube dysfunction has been shown as one of the factors causing failure in tympanoplasty. It is known that bilateral disease and decreased in mastoid pneumatization are associated with Eustachian tube (ET) dysfunction. In this study, the relationship between the success of type 1 tympanoplasty and mastoid pneumatization, bilateral disease and ET function was investigated. Materials and Methods: A total of 44 patients who were operated for chronic otitis media in our clinic were included. The information of the patients was obtained retrospectively, the direction of the disease (bilateral/unilateral), the status of the graft (intact/perforated), mastoid pneumatization status, and hearing levels (preoperative/postoperative 6th month) were noted. Automatic Williams test was used to tympanometrically evaluate ET functions (ETF) in postoperative period. The relationship between tympanoplasty success and mastoid pneumatization, bilateral disease and ETF was investigated by statistical analysis. Results: The disease aspect was found bilateral in 34.1% (n = 15) of the cases, and unilateral in 65.9% (n = 29) of the cases. Mastoid pneumatization was decreased in 52.2% (n = 23) of the cases, and normal in 45.4% (n = 20). The preoperative air-bone mean difference (gap) of the cases with decreased mastoid pneumatization was found to be statistically significantly higher than the cases with normal mastoid pneumatization (p < 0.05). The closure of the postoperative air-bone gap in patients with unilateral disease direction was found to be statistically significantly higher than in patients with bilateral disease direction (p < 0.05). Also we found significantly worse ET functions both in unilateral and bilateral disease. Conclusion: Preoperative air-bone gap average is higher in ears with decreased mastoid pneumatization, and postoperative air-bone gap closure is higher in unilateral patients. Mastoid ventilation does not make a significant difference in the success of type 1 tympanoplasty. On the other hand, our results support that ET dysfunction can be effective in the occurrence of chronic otitis media (COM). [ABSTRACT FROM AUTHOR]

Introduction: Complete surgical removal of cholesteatoma has been traditionally performed by microscopic approaches. In recent years, use of endoscopes in middle ear surgery is gaining increasing importance. The wide field view offered by the endoscopes in comparison to the narrow field of view of the binocular microscope enables a surgeon to see and dissect around corners, thereby exposing 'hidden recesses' of the middle ear which can be useful during cholesteatoma surgery. To identify remnant cholesteatoma in difficult access sites of the middle ear cleft using endoscopes following a microscope assisted mastoidectomy. A cross sectional study was conducted in patients who were clinically diagnosed with cholesteatoma. Patients were subjected to High Resolution Computed Tomography of the temporal bone and pre-operative audiological tests. Mastoid exploration was performed microscopically followed by endoscopic evaluation and clearance of disease in the same setting. Patients were then followed up post-operative and endoscopically evaluated to look for any remnant disease. A total of 45 patients were included, all of which underwent microscopic assisted mastoidectomy. Remnant cholesteatoma was discovered in 15 out of 45 cases (33%) distributed in the hidden areas; in the region of sinus tympani 9(60%), anterior epitympanum 4(27%), hypotympanum 1(7%) and tip Cells 1(7%). It can be concluded that endoscopes have a definite role in evaluation and complete surgical clearance of cholesteatoma particularly from the hidden areas of middle ear cleft which would have otherwise been missed by the straight line view of a microscope thereby grossly reducing the rate of remnant disease. [ABSTRACT FROM AUTHOR]

Morphometry of pinna may change following ear surgeries. This study gives information about postoperative changes following ear surgeries. This study aims to measure the variation of ear morphology following surgery and to correlate the type of surgery with post-operative variations. Eighty patients with Chronic Otitis Media(COM) undergoing surgery by post aural approach were grouped into Modified Radical Mastoidectomy (MRM), Cortical Mastoidectomy + Tympanoplasty (CM + TM) and Tympanoplasty groups(TM). The MRM, CM + TM and TM groups had 14, 46 and 20 participants respectively. Various morphometric measurements were taken pre and post operatively. In all groups, the mean Concho-Mastoid Angle (CMA) was increased post operatively, with increase of 11.1 degrees in MRM (p value-0.002), 8.9 degrees in CM + TM (p value-0.000) and 4.8 degrees (p value- 0.657) in TM group. Similarly, the Cepahlo-auricular distances (D1 and D2) showed statistically significant changes in MRM and CM + TM groups (p value < 0.05). Mean CMA of MRM group compared with other groups did not show any statistically significant difference. However, when the CMA of CM + TM group was compared with TM group showed significant difference of 14.53 degree (p value 0.002). Similarly, the D1 and D2 showed statistically significant changes between the CM + TM and TM groups (p value 0.005 and 0.000 respectively). Prominence of pinna following ear surgery is a not a myth. It happens mostly in cases requiring drilling of the mastoid, rather than Tympanoplasty alone. This needs to be explained to the patient beforehand to prevent any confusion post operatively. [ABSTRACT FROM AUTHOR]

To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the correlation of eustachian tube function with the results—i.e., success or failure of tympanoplasty in these patients in terms of graft uptake. This was a prospective observational study carried out over one and half years in Department of E.N.T. & Head and Neck Surgery, a tertiary care hospital. The study group comprised of eighty-seven patients who were diagnosed with chronic otitis media mucosal type- inactive stage and were planned for tympanoplasty or tympanoplasty with cortical mastoidectomy. Written informed consent was taken from all patients. The eustachian tube function was assessed preoperatively by impedance audiometry (Toynbee's test). The surgical outcome was tested by looking at the status of the tympanic membrane postoperatively. The surgical outcome in terms of whether a defect was present in the tympanic membrane was compared with the preoperative eustachian tube function. 98.6% of patients with successful surgical outcome had normal eustachian tube function preoperatively while the neo-tympanic membrane was intact in 63.63% and 33.33% of patients with pre-operative partially impaired and grossly impaired eustachian tube function respectively. From our study, we concluded there was a strong association between functioning eustachian tube and graft uptake in tympanoplasty. So eustachian tube plays important role in successful outcome of surgery. [ABSTRACT FROM AUTHOR]

Introduction: Chronic suppurative otitis media (CSOM) is a long standing infection of the middle ear cleft. Mastoidectomy, with or without tympanoplasty, is the preferred treatment for CSOM. However, the drill used during ear surgery generates noise that may potentially cause hearing damage in both the operated and opposite inner ear, leading to temporary or permanent hearing loss. Materials and Methods: The study included patients diagnosed with CSOM who underwent surgeries in the Otorhinolaryngology department. Postoperatively, all patients were followed up on the 7th day and 1 month after the surgery. Pure Tone Audiometry (PTA) was performed to evaluate the hearing outcomes. Results: A total of 61 patients were included in the study. The mean preoperative PTA of contralateral ear bone conduction among the study participants was 6.48. At the 7th day post-operation, the mean post-operative PTA of contralateral ear bone conduction for the same participants was 7.77. This difference was statistically significant according to the Paired T-test (P = 0.001).However, when evaluating the mean preoperative PTA of contralateral ear bone conduction (6.48) and the mean post-operative PTA at 1st month (6.02), the difference was not statistically significant (P = 0.208).Additionally, there was no statistical difference in air conduction and air-bone gap before and after surgery. Conclusion: The study suggests that mastoid drilling is associated with a significant temporary hearing loss in the contralateral ear immediately after surgery, which eventually recovers within a month. However, the hearing loss is considered negligible and not statistically significant in the long term. It is worth considering additional audiological investigations, such as otoacoustic emissions, to detect this type of hearing loss more accurately. [ABSTRACT FROM AUTHOR]

The primary objective of mastoid obliteration is the eradication of the disease and prevention of its recurrence. We intend to evaluate the impact of mastoid obliteration using autologous materials on the achievement of a dry mastoid bowl and frequency of maintenance care and hearing outcome of the operated ear. This was a hospital-based, non – randomized, prospective study. The study was performed over a period of 2 years. The study was performed in the Department of ENT of a tertiary care teaching hospital. Patients of chronic otitis media – squamosal type underwent canal wall down mastoidectomy and patients were divided into 2 groups of obliterated and non-obliterated. The canal wall obliterated patients were further compared in 3 groups based on the technique of mastoid obliteration used – bone dust, musculo-periosteal flap and cartilage graft. 6 months post-operative mastoid cavity epithelisation based on oto-microscopy and hearing outcome based on pure tone audiometry findings were compared. Majority of patients at 6-months follow-up found that epithelization was most common status of mastoid cavity with musculoperiosteal flap and discharge was commonest with cartilage graft. Mastoid obliteration with autologous materials is a safe and effective method to achieve a dry, safe and useful ear. In this study, musculo-periosteal flap being significantly better in terms of a well epithelized cavity and hearing outcome. [ABSTRACT FROM AUTHOR]

The temporal bone is a complex anatomical space that houses the middle ear and its ossicles, as well as the inner ear, which includes the vestibule, cochlea, and the semicircular canals. Henle's spine, also known as the suprameatal spine/spina suprameatica/ is found to guide the lateral wall of the mastoid antrum [J Res Med Dent Sci 8(7):420–422, Stat-Pearls Publishing, Treasure Island. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559153/]. It is found that the Henle's spine is present in 85% of the human skulls and when present, it could be used as a reliable anatomical landmark for isolating various foramina during skull base surgeries [J Laryngol Otol 119:856–861], and to assess the location of handle of malleus and subsequently the mastoid antrum, in many cases. We present here 3 cases in which tympanoplasty was planned, and the position of spine of Henle was found to be anterosuperior and so was the handle of malleus. Antrostomy was done by following the spine of Henle in all cases to establish patency and maintain ventilation in the post-operative ear. These 3 cases had a much more anteriorly placed spine. Such cases need to be reported so that it creates a paradigm shift in the way that mastoid surgeries are being done. Any variation in the positioning of the spine of henle points to variability in the position of the mastoid antrum. This is extremely important while drilling the mastoid in the correct position and also to prevent drilling over the sigmoid sinus or the dura. To conclude, an anteriorly placed spine of Henle corresponds to anteriorly placed mastoid antrum. [ABSTRACT FROM AUTHOR]

Labyrinthine fistula is one of the most frequent complications of cholesteatoma otitis. We report two cases where a canal wall down mastoidectomy is made due to the characteristics of the cholesteatoma, achieving good outcomes in relation to bone conductive hearing. [ABSTRACT FROM AUTHOR]

Background: Chronic otitis media (COM) is a pathology involving the middle ear cleft characterized by discharging ear and a non-healing perforation in tympanic membrane. Different techniques have been used for closing the perforation but interlay myringoplasty has become popular among surgeons since the past few decades. Objectives: To evaluate and compare the success rate of Type-1 interlay tympanoplasty in large tympanic membrane perforation with or without cortical mastoidectomy in terms of graft take-up rate and improvement in hearing outcomes. Materials and methods: A retrospective study for the period of eighteen months with total of 90 patients further subdivided into two groups. Group I of 45 patients underwent Type-1 interlay tympanoplasty alone, and 45 patients in Group II underwent type-1 interlay tympanoplasty with cortical mastoidectomy. Results: In group I the mean pre-operative, post-operative pure tone average and air bone gap was found to be 36.49 ± 4.49, 29.24 ± 4.39 and 25.11 ± 3.15, 14.76 ± 3.12 respectively. In group II the mean pre-operative, post-operative pure tone average and air bone gap was found to be 35.60 ± 5.27, 25.96 ± 5.29 and 23.96 ± 3.76 and 13.33 ± 3.38. An independent sample t-test was performed for intergroup comparison and found to be statistically significant (p < 0.005). The graft uptake was 95.5% in group II and 82.2% in group I. Conclusion: Interlay type-1 tympanoplasty coupled with cortical mastoidectomy gives excellent results in terms air bone gap closure and graft uptake in inactive mucosal COM than Interlay type-1 tympanoplasty alone. [ABSTRACT FROM AUTHOR]

Aims: To identify the causes of failure of the canal wall down mastoidectomy and evaluate the causes for discharging mastoid cavity and to address the causes of failure of previous surgery to minimize the Revision surgery. Materials and methods: This was a prospective and retrospective observational study conducted at a tertiary care hospital from May 2019 to December 2021. Total 20 Patients (11 male & 9 female) with age group (0–60 years) who previously underwent canal wall down mastoidectomy and presented with complaints of persistent ear discharge were included. All patients underwent otoscopic, oto-endoscopic and microscopic examination. Results: Out of 20 cases,13 cases had residual/recurrent cholesteatoma, 11 cases had narrow meatoplasty and 9 cases had high facial ridge.Other causes for failure are graft defect, incomplete removal of anterior and posterior buttress. Conclusion: Recurrent/residual cholesteatoma and Narrow meatoplasty are most common cause for failure of previous surgery. Persistent granulation at un-exenterated area was the most common cause for suppuration. Regular follow up and cleaning of the debris from cavity enhances the epithelialization and healing of the cavity. [ABSTRACT FROM AUTHOR]

Objective: To study and analyse the result obtained in cochlear implantation by Veria technique and evaluate the incidence of surgical complications and their management. Method: Between Jan 1, 2014 to Jan 1, 2019, 602 cochlear implantations by Veria technique were done out of which 576 patients were analysed retrospectively for the study. The age range was between 18 months and 60 years. Result: All 576 patients were operated by Veria technique. Out of 576 patients, 57 (9.9%) had abnormal cochlear malformation. Cytomegalovirus (CMV) being the most common non genetic cause of congenital hearing loss accounting to 60%. The overall complication rate of 5.5% was observed in 576 implanted patients. Conclusion: The analysis of the results shows that this method has certain advantages, which are: it is simple and therefore the learning curve is fast; it is safe for the facial nerve, as the drilling is precisely controlled by the special perforator; it produces minimal bone trauma and due fast healing, it permits early fitting a few days after operation; it can be used for very small children where the mastoid may have not been yet sufficiently developed. [ABSTRACT FROM AUTHOR]

To provide a systematic review on the use of additional anticoagulation in the management of otogenic sigmoid sinus thrombosis when compared with the cohort not receiving the anticoagulation. A systematic review until 2021 was done and relevant studies were screened. Based on a selective criteria, a database is constituted which were then rearranged and studied. 16 articles were selected with 113 patients. The group who received anticoagulation had more complications (23.33%) in comparison (21.74%), whereas the recanalization was successful in the anticoagulated group, 76.67%, as against 39.13%. In 74/90 patients who underwent mastoidectomy with anticoagulation, the recanalization and complication were 72.97% and 25.68% respectively. The second group with 16/90 patients who received conservative treatment, the recanalization and complication rates were 93.75% and 12.50% respectively. The third group with 23 patients were treated with mastoidectomy and antibiotics but didn't receive anticoagulants in which the recanalization achieved in 39.13% with a complication rate of 21.74%. For those patients who underwent mastoidectomy with concurrent anticoagulation, 44 showed radiological evidence of recanalization, and in sixteen patients that received the same treatment, no recanalization was achieved whereas in patients who received conservative treatment with anticoagulation, 12 patients showed recanalization and finally, for the patients underwent surgery without anticoagulation, five patients achieved recanalization and 7 did not become recanalized (14.29%). Recanalization seems more pronounced in those who were anticoagulated, but, did not seem to influence the clinical outcome. Complications were more in those who were undergone surgery with or without anticoagulation. [ABSTRACT FROM AUTHOR]

Endoscopic Ear surgery is evolving day by day and there is need for constant improvement in terms of instrumentation with efficient, quicker, with clear bloodless surgical field and good postoperative outcome and results. The application of Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet are presented. This innovation will provide limited and adequate bone removal in a faster way than drill in endoscopic mastoidectomy and stapedotomy surgeries. Surgical instruments represent a major financial asset to the health care facilities. The use of Dr Ahila's Endoscopic Ear Surgery straight 1 mm or 2 mm Chisel and Mallet is presented. Dr Ahila's Endoscopic Ear Surgery Chisel and Mallet, this innovation will provide faster bone removal than drill or curette without bone dust formation, fogging, irrigation in Endoscopic mastoidectomy and stapedotomy. This instrument is essential to avoid costly replacement, surgeon satisfaction, reduce cost and delays in the operating room and in safe and trained hands enhance patient safety. [ABSTRACT FROM AUTHOR]

The indications for revision middle ear surgery are inter-linked to the objectives of surgery and needs of the patient. Revision middle ear surgery is often challengingly arduous not only for the patient but for the surgeon as well. This study concentrates on the causes of failures of primary ear surgery, indications, techniques, outcomes and lessons learned in revision ear surgery. This retrospectivedescriptive study included 22 cases (12.29%) of revision surgery,with a follow up of at least one year, out of total 179 cases of middle ear surgeries performed over a period of 5 years.These revision cases included tympanoplasty, cortical mastoidectomy and modified radical mastoidectomy alongwith ossiculoplasty and scutumplasty, wherever required. Hearing improvement, closure of perforation, and prevention of recrudescence were the main outcome parameters. The overall morphologic success of revision surgery in our series was 90.90%.There was one graft failure, one attic retraction and the main complication observed was post-operative worsening of hearing.Mean postoperative pure-tone average air -bone gap (ABG) was 20.86 ± 11.29 dB compared with preoperative ABG of 29.64 ± 10.63 dB and the difference was statistically significant (p < 0.05) with p value 0.0112 on paired t-test. Detailed knowledge and anticipation of the cause of failure is a must in preventing another failure in revision ear surgeries. Hearing preservation must be considered in a pragmatic perspective and accordingly surgical indications must complement the realistic and reasonable expectations of the patients. [ABSTRACT FROM AUTHOR]

Sigmoid sinus and transverse sinus thrombosis may occur as intracranial complications of chronic otitis media. Central venous sinus thrombosis typically presents with picket fence fever along with otalgia, otorrhea, and altered mental status. CT and MRI are investigations of choice for diagnosis. Once diagnosed, one should be started on empiric antibiotics. The use of anticoagulants has been debatable. From a surgical point of view, the current trend is to perform a mastoidectomy with the removal of inflammatory tissue from the sinus walls. [ABSTRACT FROM AUTHOR]

The functional aspect of preservation of every healthy anatomical structure, particularly the ossicles, non-diseased mastoid cortex and middle ear mucosa, and to achieve this by transacanal endoscopic dual hand approach to middle ear, aditus and mastoid antrum with minimal posterior atticotomy and proximal aditotomy. The prospective study has been conducted over a period of 12 years from 2009 to 2021 in the Jorhat Medical College, Assam Medical College and Niramoy Hospital, Jorhat, Assam. Follow up was for a minimum of 4 years. The current study was a prospective hospital based study, carried out from May 1st, 2009 to April 30th, 2021 involving 157 subjects from 18 to 65 years with mean age of 38 + 2.5. Graft uptake rate of 93.6%. Minimal atticotomy with proximal aditotomy offers a clear view of the antrum with angled scopes of 30 degree and 45 degree and if any disease is located it can be removed through the transcanal approach with angled instruments and aditus patency can be confirmed by visual inspection. Hence, decreasing the need of unnecessary bone drilling as done with cortical mastoidectomy to create a parallel view.The endoscopic ear surgeries done with "dual hand endo-holder" were uneventful and much more comfortable as compared to the single hand technique. Functional approach by minimizing bone drilling, reestablishment of ventilation pathways and preservation of ossicles with disease clearance give better postoperative results in long term follow-up. [ABSTRACT FROM AUTHOR]

Chronic Otitis Media—Squamosal type is an erosive process, which when confined to ossicular chain causes varying degrees of hearing impairment. As the disease progresses to involve surrounding vital structures, it causes various complications like facial palsy, vertigo, mastoid abscess, which are more common than the other intracranial complications, and require a definitive surgical intervention i.e., mastoidectomy at the earliest. A retrospective study on 60 patients who had been operated for squamosal type were analysed for the demographics, symptomatology, intraoperative extent of cholesteatoma, type of mastoidectomy done, various graft materials used for reconstruction, post operatively for graft uptake, hearing improvement and the results were analysed using ChOLE classification of cholesteatoma. Although Intact Canal Wall mastoidectomy had improved post op PTA values, there was no significant difference in the Air–Bone gap closure when Intact Canal Wall mastoidectomy was compared to Canal Wall Down Mastoidectomy. [ABSTRACT FROM AUTHOR]

A cadaveric study to know the anatomical and radiological correlation between the mastoid air cell system in relation to its volume and morphology. This is a rare and one of its kind of cadaveric study on temporal bone in which comparison of pre dissection and post cortical mastoidectomy dissection on x-ray mastoid in relation to their dimensions. To study the anatomical and radiological correlation of mastoid air cell system in relation to its morphology using pre and post dissection x-ray measurements and dissection method. 30 adult cadaveric, temporal bone cortical mastoidectomy dissections were performed and X-ray mastoid with a pre and post mastoid dissection measurements using vernier caliper was done. Further 3-D analysis of volume of mastoid cavity compared with a post dissection digital radiographic measurements was carried out. On statistical analysis, mean surface area of MACS, shortest length between sigmoidsinus and posterior wall of EAC, also shortest distance between dural plate and mastoid tip, in pre and post dissection x-ray mastoid and in direct mastoid cavity measurements were not found to be significant. Mastoidectomy being the treatment of choice in day to day practise in many cases this study hopes to add up to the present understanding for the MACS dynamics and assesses the possible anatomical variations that can exist. This study helps us to find the approximate time required for surgery to perform cortical mastoidectomy. [ABSTRACT FROM AUTHOR]

Introduction: Endoscopic Denker's approach involves complete exposure of the anterior, inferior and lateral walls of the maxillary sinus providing access to both infratemporal and pterygopalatine fossa. Open approaches to maxillary sinus may lead to a high chance of cranial nerve dysfunction, trismus and wound healing issues. Surgical methods differ based on pathology, exposure, visualization and extent of clearance of the pathology. Method: The technique and surgical steps of Endoscopic Reverse Denker's approach are presented. Results: Critical steps include inferior turbinectomy, uncinectomy, followed by mega middle meatal antrostomy. For exposure drilling is started from the anterior margin of middle meatal antrostomy up to the pyriform aperture anteriorly till the anterior wall of the maxilla is visualized and the nasolacrimal duct can be visualized and transected. This method preserves the pyriform aperture and anterior wall similar to inside-out mastoidectomy tracing the pathology with less bone removal, faster and less morbidity. Conclusion: Endoscopic Reverse Denker's is a 2-handed or 4-handed endoscopic technique for proper exposure, visualization and clearance of the maxillary pathology of the anterolateral and anterior wall. Olfaction is preserved and crusting is less as there is less bone removal with no atrophic nasal changes. It preserves the pyriform aperture thereby preventing alar collapse. [ABSTRACT FROM AUTHOR]

Chronic otits media (COM) is surgically treatable disease which includes complete removal of disease and improving hearing via ossicular reconstruction. Therefore, thorough assessment of the disease, ossicles and various factors causing it plays a major role in surgical outcome prediction. MERI (Middle ear risk index) is one such tool being used worldwide. Our aim was to evaluate the surgical outcome of tympanomastoid surgery using MERI and find out correlation between them as well as categorize cases into their severity score in a developing country. Observational prospective study conducted in a tertiary care center. 200 patients were included. After complete history and examination, they were given MERI scores and prediction of surgical outcome was done. Postoperatively it was compared with the real outcome of the surgery. Out of 200 patients, 71.5% had mild, 15.5% had moderate and 13% had severe MERI scores preoperatively. There was a success rate of 88.5% in graft uptake and the mean score of hearing benefit (A-B gain) among patients was 8.75 ± 8.82 dB postoperatively. MERI may be used as a prognostic indicator for predicting surgical outcome. Based on the MERI score, chances of surgical success and hearing benefit can be explained to the patient with certain limitations. [ABSTRACT FROM AUTHOR]

The objective of this retrospective study was to present the experience on the management of labyrinthine fistula secondary to chronic otitis media in a tertiary center. 263 patients, who underwent tympanomastoidecomy, in Centro Hospitalar Universitário do Porto, between 2015 and 2020 were reviewed, to select only those with labyrinthine fistulas. 26 patients (9.89%) had cholesteatoma complicated by fistula of the lateral semicircular canal. Most frequent symptoms were unspecific, such as otorrhea, hearing loss and dizziness. Preoperative high-resolution computed tomography predicted fistula in 54%. Using the Dornhoffer and Milewski classification, 10 cases (38.46%) were identified as stage I, 15 (57.69%) at stage II, and 1 (3.85%) as stage III. The choice between open or closed surgical procedure was independent of the type of fistulae. The cholesteatoma matrix was completely removed from the fistula and immediately covered by autogenous material. In one patient matrix was left over the fistula. After surgery, hearing (bone conduction) was preserved or improved in 73% of the patients. There was no statistically significant relationship between the extent of the labyrinthine fistula, type of material used in fistula repair and the hearing outcome. Also, we didn't find a statistically significant relationship between extent of the labyrinthine fistula and the presence of facial nerve canal dehiscence, tegmen timpani erosion, sigmoid sinus exposure or ossicular bone erosions. In conclusion, a complete and nontraumatic removal of cholesteatoma matrix over the fistula in a single-staged procedure, is a safe and effective procedure, which achieves a hearing preservation or improvement in most cases. [ABSTRACT FROM AUTHOR]

For a chronically discharging ear open mastoidectomy is the mainstay of treatment, however it can cause high morbidity due a large cavity and complications like discharge, vertigo and difficulty with hearing aids. To avoid such problem, obliteration of mastoid cavity is done. The objective of our study was to compare the post-operative complains, the hearing results and outcomes of open and closed mastoid cavity. The present prospective study was conducted on 40 patients having attico-antral disease in middle ear cleft. Patients were randomly divided into two groups of 20 each. Out of 40 patients, in 20 patients (Group A) mastoid obliteration was done using conchal cartilage, whereas in other 20 patients (Group B) canal wall down mastoidectomy without mastoid obliteration was done i.e.an open cavity. The patients were followed up post-operatively at 6th week, 3rd month and 6th month. Study Design: comparative study. On Pure Tone Audiometry, 13 (65%) patients with closed mastoid cavity had Air–bone Gap < 30 dB, 7 (35%) were in the range 30–60 dB as compared to open mastoid cavity where 10 (20%), 8 (40%), 2(10%) patients had ABG < 30db, 30–60 dB, and > 60 dB respectively, showing better hearing results in obliterated cavities, healing was also better. In obliterated mastoid cavities, there were very few complications of pain, discharge, and giddiness compared to open cavities. Healing as shown by epithelisation was earlier and better in obliterated cavities. Hearing results were better in mastoid cavities with obliteration compared to open cavities. Patients with obliterated mastoid cavity need less cavity care and doctor dependence. [ABSTRACT FROM AUTHOR]

In middle ear surgeries, addressing the pathologies (cholesteatoma, retractions or tympanosclerosis) in attic or postero-superior area, are associated with difficulties like reconstruction of attic and postero-superior canal wall after clearing the disease. There are various graft materials available for such attic reconstruction in intact canal -wall surgeries. We describe our experience of attic and postero-superior canal wall reconstruction in combined approach tympanoplasty (CAT) using free auricular cartilage and free fibro-periosteal tissue and to present our results in anatomical and functional perspectives. This retrospective observational study was conducted in a tertiary care center which comprised 25 cases of combined approach tympanoplasty (with attic wall reconstruction) which were operated for attic cholesteatoma, tympanosclerosis or adhesive otitis media from January 2017 to December 2019 in our otolaryngology department. Outcomes were evaluated in audiological and morphological dimensions and paired "t" test (significant p value < 0.05) was used to analyse the audiological data. A total of 25 cases (22 primary and 3 revision cases) were included in the study. Defect in attic and posterosuperior canal wall was caused by pathology (disease itself) in 2 cases, surgically created (intraoperatively to clear the disease) in 11 cases and both by pathology and surgically in 12 cases. 22 cases had successful graft uptake, with a morphological success rate of 88%, whereas graft failure was encountered in 3 cases. Complications observed were post-operative otorrhea (2 cases), recurrence (3 cases), no hearing improvement despite intact graft (1 case) and worsening of hearing post operatively in 1 case. Pre-operative ACT (Air conduction threshold) was 45.96 ± 12.47 dB and the post-operative ACT was 38.61 ± 9.76 dB (p value = 0.0246). Pre-operative ABG (Air–bone gap) was reduced from 30.58 ± 11.06 dB to the post-operative ABG of 21.89 ± 6.24 dB (p value = 0.0013). Reconstruction of postero-superior canal wall and attic defects in CAT using auricular cartilage and fibro-periosteal tissue (over mastoid cortex) is a novel method and associated with satisfactory morphological and audiological results. It is also effective in preventing postoperative retractions. [ABSTRACT FROM AUTHOR]

To compare the volume of cortical bone dust collected and the time taken for bone dust collection by using a self-devised bone dust collector and that by manual method using a metal scoop in patients undergoing modified radical mastoidectomy with mastoid cavity obliteration. A prospective study was done in 62 patients of cholesteatoma. They underwent canal wall down mastoidectomy. Mastoid cavity was obliteration was done using cortical bone dust collected after dividing the patients randomly into 2 groups: (1) using a collector device made using a mucous extractor fitted with a nylon mesh of size 1″ × 3″ attached to the suction tube, (2) collected manually by using a metal scoop. The time taken for the collection of bone dust was recorded and the volume of bone dust collected was measured and recorded. We found that the time taken for the collection of bone dust was significantly lower and the volume of bone dust collected was higher using a mucous extractor as compared to that by manual collection using a metal scoop. The suction based mucous extractor performed better in terms of both time taken for collection and also in the volume of cortical bone dust that was collected as compared to manual collection using a metal scoop. Therefore, we conclude from our study that using the suction based mucous extractor is a more effective method of cortical bone dust collection for mastoid cavity obliteration. [ABSTRACT FROM AUTHOR]

We have developed a novel instrument which is a drill burr protection sheath with an inbuilt suction-irrigation system for endoscopic ear surgery. It allows simultaneous suction and irrigation. It is a metallic attachment onto the mastoid drill handpiece. It provides protection for the endoscope as well as the external auditory skin during transcanal drilling procedures. It is cost effective. Level of evidence: 5 [ABSTRACT FROM AUTHOR]

Endoscopes have revolutionized the field of otology for the past two decades due to its minimally invasive technique and improved visualization. The advantage of endoscope during surgery for middle ear cholesteatoma both for diagnosing and aiding in removal of residual disease from the hidden areas and the resulting lower recurrence rates have been proven in the past by many authors. But the feasibility of totally endoscopic ear surgery and its surgical and patient related outcomes are yet to be explored in detail. We conducted this systematic review and meta-analysis to compare the surgical and patient related outcomes between totally endoscopic and microscopic technique in cases of acquired middle ear cholesteatoma. This meta-analysis has been conducted as per Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Search engines used to identify the eligible articles were Pubmed, Web of Science, Cochrane Library, Virtual Health Library databases. The studies that compared the outcomes of microscopic and endoscopic techniques in case of acquired middle ear cholesteatoma and with more than 10 patients were included. Outcomes like recurrence, residual disease, graft uptake rate, audiological outcome, conversion rate, pain score, surgery duration, complications and quality of life outcomes were compared.The quality of the included studies was assessed by Methodological Index for Non-randomized studies criteria in case of non-randomized studies and by means of Cochrane Risk of Bias Tool in case of randomized controlled studies. A random effects model was used to calculate pooled estimates. The ODDS ratio and 95% confidence interval were calculated. The heterogeneity among the studies was represented by the Q statistic and Higgins I2 statistic. The test for overall effect was calculated by Z test and a p value of < 0.05 was considered as statistically significant. 11 studies were included in this meta-analysis. Out of 11 included studies, 4 were prospectively designed and 7 were retrospective studies. The overall effect showed recurrence rate (Z:2.69, P:0.007) was lower among endoscopic technique. Post-operative pain was less among the endoscopic technique and there was no difference between the groups with respect to surgical duration. Although endoscopic technique showed lower residual rate and post-operative vertigo with better graft success rate among the individual studies, the overall analysis showed that the difference was not statistically significant. Endoscope has been an invaluable tool in the cholesteatoma surgery over the past 20 years due to its excellent optics and minimally invasive technique. Evaluation of the present data available in the literature reveals that both the techniques have similar outcomes except for a definite advantage of endoscopic technique in reducing the recurrence and post-operative discomfort. [ABSTRACT FROM AUTHOR]

Ossicular discontinuity is one of the most common causes of conductive hearing loss. Ossicular chain reconstruction improves conductive hearing loss. With no additional cost, cartilage ossiculoplasty is easy to perform, and also the cartilage is well tolerated being an autograft. In this study we compared the audiological outcome in ossiculoplasty done by cartilage umbrella, cartilage boomerang and alloplastic TORP. 75 patients of age group 10–50 years clinically diagnosed with chronic otitis media with conductive hearing loss and an air bone gap (ABG) of at least 20 dB posted for surgery were included. Ossiculoplasty was done in three groups with autologous cartilage boomerang, cartilage umbrella and alloplastic TORP. In mucosal disease hearing gain was better in umbrella technique (17.66 ± 1.1) dB than Boomerang (16.9 ± 0.8) dB and TORP (10.68 ± 0.9) dB. ABG closure was higher in Boomerang and TORP. Hearing improvement in patients with squamosal disease managed by canal wall up surgery was 25.01 ± 1.1 dB, 27.73 ± 3.1 dB and 20.12 ± 1.8 dB in Boomerang, Umbrella and TORP group respectively showing that umbrella method gave maximum improvement. ABG closure was better in TORP group. In canal wall down surgery patient's maximum improvement was seen in Boomerang (29.51 ± 0.9) dB followed by Umbrella (26.67 ± 1.2) dB and TORP (25.27 ± 0.8) dB group. ABG closure was higher in Boomerang group. Cartilage ossiculoplasty is a reliable and effective method of ossicular chain reconstruction for both mucosal and squamosal disease. Cartilage ossiculoplasty has the added advantage of reduced chances of prosthesis extrusion as compared to TORP. [ABSTRACT FROM AUTHOR]

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 250 Hz–8000 Hz 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, 4000 Hz, 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. [ABSTRACT FROM AUTHOR]

Cartilage is used in middle ear surgery for reconstruction of tympanic membrane, ossicular chain, posterior canal wall and lateral attic wall. When used in tympanic membrane reconstruction, thickness of the cartilage is thought to interfere with the sound conduction. In our otology practice for tympanic membrane reconstruction, we prefer the sliced cartilage graft to achieve acoustic benefit. We have used a microdermatome for precise reduction of the thickness of the cartilage. This also allows us to select exact thickness of cartilage slice and also permits slicing from donor site directly. To describe the use of novel method of cartilage slicing using a micro dermatome and to report our preliminary experience. This is a descriptive study, with a total number of 350 cartilage grafts used in tympanoplasty and mastoidectomies have been prepared with micro dermatome from 2019 to 2021. Our study reports the technique of slicing the Conchal cartilage and how its uniform measurement can be obtained. Our modified technique using the micro dermatome is easy to master, provides precise cartilage thickness as per needs within a short span of time. Harvesting from the donor site is as per the graft requirement and rest of the cartilage is left in place for the future revision surgery if needed. The cartilage obtained were structurally integral without any undue breakage and functionally stable. The thickness of the cartilages obtained makes it pliable for easy handling and placement in ear surgeries. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to assess the value of the diffusion MRI with the non-echoplanar imaging (Non-EPI) technique for follow-up the post-operative patients to detect residual cholesteatomas. Study design: This prospective study was performed on 40 patients. All patients were at least one year after Canal Wall Up mastoidectomy surgery for cholesteatoma and scheduled for a second-look surgery. Patients and Methods: This prospective study was performed on 40 patients. All patients were subjected to Canal Wall Up surgery and planned for the second-look operation. After one year as removal of choleasteatoma is uncertain in first surgery. The study done at Tertiary referral centers (Ain shams, Mansoura, and Minia university hospitals), non-echoplanar diffusion MRI (NEP-DWI) technique for follow-up the post-operative patients to detect residual cholesteatomas, then second look surgery done 2 weeks after MRI. Results: Forty patients underwent MRI with Non-echoplanar diffusion-weighted imaging (NEP-DWI). Twenty-six patients had positive MRI results with the remaining 14 patients had negative results. These results were compared to operative findings. All positive MRI cases showed positive intra-operative findings. Ten of negative MRI cases showed negative intra-operative findings. Four of DWI-negative cases showed small cholesteatomas. Conclusion: The use of NEP-DWI is a valuable tool in detecting residual cholesteatoma that could replace the second look surgery in many cases. [ABSTRACT FROM AUTHOR]

The purpose of this prospective observational study was to evaluate the diagnostic performance of non–EPI-based techniques, in detecting both primary and residual/recurrent cholesteatoma in a tertiary care center. 56 patients (25 female and 31 male) aged between 6 and 59 years were prospectively evaluated for the presence or absence of cholesteatoma. This included both primary and postoperative recurrent cholesteatoma (16). All the patients underwent sequential CT scans of temporal bones and non-EPI DWI (Non-Echo Planar Diffusion-Weighted Imaging) MRI techniques. The findings were correlated with surgical findings regarding the presence or absence of cholesteatoma. The size of cholesteatoma that was diagnosed on non-EPI DWI MRI was measured. The smallest size was 6 mm and the largest one was 21 mm. The accuracy of non-EPI DWI MRI in diagnosing cholesteatoma (primary and recurrent) was 97.5%. Whereas in diagnosing recurrent cholesteatoma accuracy was 100%. Accuracy of non-EPI DWI MRI is very high in diagnosing cholesteatoma especially in recurrent cholesteatoma and can potentially replace second look surgery when intact canal wall techniques are used. The technique is best used with a CT Scan of the temporal bone to depict bony changes, anatomical variants, or complications. The combination of HRCT and non-EPI DWI needs to be employed in diagnosing primary and recurrent cholesteatoma to maximize the diagnostic benefit as they are complimentary. [ABSTRACT FROM AUTHOR]

Mastoidectomy forms the main surgical procedure for eradication of disease in chronic otitis media. Such a surgery which contemplates a complete exenteration of all the tympano-mastoid cavities is rightly considered as a difficult one mainly because a large number of vitally important structures are crowded together in the small field of operation and there is always a risk of damaging them. It is therefore, extremely important that the otologist who would undertake this surgery be thorough with the details of the surgical relations of this region. Out of the various structures seen on the lateral surface of temporal bone one very important structure is the suprameatal spine. It is shown to have great variations in shape and size and has been a mystery to researchers due to the implications it is known to have on mastoid region anatomy. In this study we have evaluated the various types of suprameatal spine, prevalence of each type and the effect of each to other landmarks encountered during surgery and also the effect of mastoid pneumatisation on the same. [ABSTRACT FROM AUTHOR]

The objective of the study was to study the outcomes of interlay type 1 tympanoplasty in large central perforations in terms of graft uptake, hearing improvement and complications. Study included 150 symptomatic patients having large central perforation in tympanic membrane willing for surgery who later underwent tympanoplasty with or without cortical mastoidectomy. All the patients selected for study, were assessed for subjective and objective evaluation pre-operatively and then post-operatively after 4 months. The study was conducted at tertiary health care hospital. Type I tympanoplasty with Interlay technique for large central perforations is superior. The Interlay technique in Type I tympanoplasty has high success both in terms of graft uptake as well as ABG closure. In the view of the advantages it offers, it should be preferred over the other conventional techniques in patients with large central perforations for better results. [ABSTRACT FROM AUTHOR]

Facial nerve paralysis is one of the most common symptom an otology surgeon comes across. Aim of this article is to review the literature, to study the important causes, pathogenesis and to know the common sites of involvement in different types of facial paralysis with importance of imaging in identifying the site of lesion and role of surgery and outcome of conservative management in case of infranuclear facial paralysis. This is a prospective study of 23 cases of infranuclear facial paralysis in case of post-head injury, post-mastoidectomy and otitis media. Facial paralysis due to post head injury is more common in adult males due to their active life and road traffic accident is the main cause. Longitudinal Fracture of temporal bone is a common fracture and it accounts for more number of facial paralysis. Decompression of the Facial nerve has beneficial effects. HRCT delineates the status of facial nerve in intratemporal part. Cholesteatoma and granulation tissue both play equal causative role for facial paralysis in otitis media. [ABSTRACT FROM AUTHOR]

The science of endoscopic ear surgery is gaining popularity and increasing momentum with reported outcomes comparable to conventional microscopic ear surgery. Endoscopic ear surgery has numerous advantages including access to visualization of occult areas of middle ear like sinus tympani. The endoscopic transcanal mastoidectomy via conventional drilling technique(Inside-out) has also established itself as a successful procedure with excellent post-operative outcomes. However, transcanal drilling is a challenging procedure as it requires extreme coordination, repeated irrigation and suction, injury to vital structures, tympanomeatal flap tear. We here propose a novel technique of doing Endoscopic transcanal mastoidectomy using upcutting and downcutting, straight and angled Paediatric Kerrison’s punch to remove the attic and posterosuperior bony canal wall with substantial benefits of significant reduction in chances of injury to vital structures, no repeated suction-irrigation required, less operative time and good visualization. Paediatric Kerrison’s punch is an instrument which is essentially available in the armamentarium of all ENT surgeons as it has been used since a long time in dacryocystorhinostomy surgery. In our quest for simplifying transcanal mastoidectomy, we have devised a novel utility of this same punch in the otology surgery. And in our experience, it has proven a pragmatic instrument in the otology surgeries as much as it is in the nasal surgeries. [ABSTRACT FROM AUTHOR]

The aim of this study is to evaluate the necessity of high resolution computed tomography (HRCT) temporal bone in patients with active squamosal chronic otitis media, by comparing the preoperative HRCT temporal bone findings with intra operative findings in a tertiary care health center where patient load is tremendous.This study was conducted in the department of otorhinolaryngology, over a period of two years from November 2017 to November 2019 in which 100 patients with active squamosal chronic otitis media diagnosed clinically were taken. All patients underwent preoperative HRCT temporal bone and subsequent tympanomastoidectomy.The results of HRCT temporal bone of all the patients were evaluated and correlated with intraoperative findings which revealed that HRCT is highly sensitive for detecting,soft tissue extension, tympanic membrane perforation, ossicular erosion, tegmen erosion, sigmoid sinus erosion, facial canal dehiscence and lateral semicircular canal fistula, which helps in guiding the surgical approach and treatment plan preoperatively. [ABSTRACT FROM AUTHOR]

This prospective study has been carried out to observe the outcomes of canal wall up (CWU) and canal wall down (CWD) Tympano-mastoidectomies in ears with cholesteatoma. Outcomes of the procedures have been done in terms of recurrence of cholesteatoma, complications, graft uptake rates and post-operative hearing gain. This study was carried out in the Department of Otorhinolaryngology of a reputed tertiary teaching hospital of North India from January 2016 to June 2020, with a mean follow-up of 32 months. The study included 100 patients of otitis media with cholesteatoma. In Canal Wall Up Tympano-mastoidectomy (CWUT) group, the number of males and females were 22 each. On the other hand, 36 males and 20 females underwent Canal Wall Down Tympano-mastoidectomy (CWDT). Each surgery was done as a single-staged and at the end of the surgical procedure angled oto-endoscopes were used for ensuring complete removal of the disease. Though there is no statistically significant difference in recurrence of cholesteatoma and complications rate in CWU and CWD Tympano-mastoidectomy techniques, but CWUT is superior to CWDT in terms of better graft uptake (p = 0.0156), and better average audiological gain (8.56 ± 0.93 dB) with p value = 0.0315. A diligent post-operative follow-up is must for assessing the outcomes of different types of mastoidectomies. This study shows no statistical difference in the disease recurrence and complication rates between Canal Wall Up and Down Tympano-mastoidectomies, though the anatomical changes and creation of the mastoid cavity in canal wall down procedure may affect the graft uptake and post-operative hearing gain. Use of Oto-endoscopes in cholesteatoma surgery helps in improving the outcomes of both techniques and thus recommended if the facility for the same is available. [ABSTRACT FROM AUTHOR]

To measure the width of the posterior tympanotomy in cadaveric temporal bones using the digital microscope and classify the round window visibility through it. In 17 cadaveric wet adult temporal bones, cortical mastoidectomy followed by posterior tympanotomy was performed, delineating the facial and chorda tympani nerves. Antero-posterior width of the facial recess was measured at the levels of oval window and round window with the help of a digital microscope and its software. Visibility of the round window through the facial recess was assessed and classified according to the St. Thomas Hospital classification. The mean antero-posterior width of the facial recess measured was 4.7 ± 0.6 mm at the level of oval window and 4.3 ± 0.7 mm at the level of round window. Round window visibility grading in bones studied were as follows-Type 1 (53%), Type 2a (24%), Type 2b (18%) and Type 3 (5%). Interobserver variability of the posterior tympanotomy measurements using the digital microscope was found to be 91.1% with a 95% confidence interval of 79 to 97% at the level of oval window and 94.1% with a 95% confidence interval (CI) of 87 to 98% at the level of round window. The visibility of the round window is not entirely dependent on the facial recess width at the round window level, suggesting that other factors like cochlear rotation may also contribute to its actual location. Measurements of micro distances with the help of digital microscope seems to be convenient, cost effective and accurate with good inter observer reliability. [ABSTRACT FROM AUTHOR]

The aim of the study was to assess the role of mastoidectomy with type 1 tympanoplasty in the management of paediatric patients with poor contralateral ear status and to evaluate the prognostic factors that may influence the success outcome of type 1 tympanoplasty. A prospective study of 112 paediatric patients from 4 to 12 years of age. All patients in the study had bilateral ear perforations. They were randomly assigned to undergo either type 1 tympanoplasty (group 1, n = 56) or type 1 tympanoplasty with mastoidectomy (group 2, n = 56). The outcomes between the two groups were compared at 12 months postoperative period. The outcomes evaluated were: 1. anatomical condition of the tympanic membrane, 2. functional improvement in hearing (≥ 10 db), 3. air-filled middle ear space without atelectasis or otitis media with effusion, 4. overall outcome. The outcomes were also compared in both the surgical groups for patients who were ≤ 8 years (n = 51) and > 8 years (n = 61) of age. Prognostic factors for success outcome for type 1 tympanoplasty were evaluated. The prognostic factors considered were age at the time of surgery, age groups, duration of the disease prior to surgery, previous adenoidectomy, mechanism of perforation, location of perforation, size of the perforation, type of ear surgery performed (tympanoplasty with or without mastoidectomy). The success outcome in anatomical condition of the tympanic membrane was significantly higher in mastoidectomy group (p = 0.015) but was not significantly different in those ≤ 8 years and > 8 years (p = 0.112, p = 0.064 respectively).There was no difference in the functional improvement in hearing in both the surgical groups for all patients, ≤ 8 years and > 8 years (p = 0.188 p = 0.061, p = 0.865 respectively). Mastoidectomy group showed significantly higher success outcome for air-filled middle ear space without atelectasis or OME for all patients, ≤ 8 years and > 8 years (p < 0.001, p = 0.004, p = 0.041 respectively).Overall success was significantly higher in mastoidectomy group for all patients and ≤ 8 years (p = 0.040, p = 0.012 respectively),but not significantly different for > 8 years (p = 0.592).Out of the prognostic factors considered for success only the type of ear surgery performed showed as a better predictor for success (AUC = 0.606, p = 0.046). Cortical mastoidectomy done along with type 1 tympanoplasty in paediatric patients with poor contralateral ear showed statistically significant higher overall success outcome. Although mastoidectomy done with type 1 tympanoplasty showed better success outcome in patients above 8 years, it was not statistically significant. Except the type of ear surgery performed, none of the prognostic factors considered could influence the success outcome. Our study recommends mastoidectomy to be combined with type 1 tympanoplasty in paediatric patients aged ≤ 8 years with poor contralateral ear status to enhance the overall success outcome. [ABSTRACT FROM AUTHOR]

Chronic Otitis Media (COM) of the squamosal type was primarily managed by performing a canal wall down mastoidectomy; however, the latter era otolaryngologist envisioned benefits in preserving the posterior canal wall. Our primary objective was to assess the disease specific quality of life following canal wall up (CWU) mastoidectomy and canal wall down (CWD) mastoidectomy surgery after a 6 month post-operative period. A prospective observational study was done from September 2017 to August 2018 where the charts of 380 patients from Christian Medical College, Vellore were reviewed. Details of patients above 18 years who had undergone the above surgeries for COM active squamosal disease from the period of January 2014 to December 2016; and had their post-operative follow up (average of 16 months) during the period of study were looked at. The CWU group had a significantly better disease-specific quality of life in the symptoms subscale than the CWD group (p value < 0.01). The CWU group showed a significant air-bone gap closure to 23.3 dB as compared to 27.7 dB in CWD (p value = 0.005). The recurrence rates were 4.5% (9 cases) in the CWU group and 3.9% (7 cases) in the CWD group, which was not statistically significant. Both CWU and CWD methods of mastoidectomy for COM squamosal type give comparable outcomes in terms of recurrence with the CWU group having a better disease-specific quality of life after surgery. Level of Evidence: 2a. [ABSTRACT FROM AUTHOR]

Prior to antibiotic era, complications rate of CSOM was 2.3 to 4% cases. With advent of newer antibiotics, radiological surgical techniques the complication greatly reduced to 0.15–0.04% and mortality decreases from 25 to 8% 5, still early diagnoses and management is still the cornerstone of prevention of CSOM complications. To study the prevalence of extracranial and intracranial complications in CSOM. It is a prospective cross sectional study done in one year from January 2018 to January 2019, at Department of ENT, G R Medical College, Gwalior, M P, India. In our study 50 patients presented with complications of CSOM during January 2018 to January 2019, ECC was found more common than ICC ECC—52%, ICC—46%, mastoid abscess was found most commonly in ECC 50%, brain abscess was the most common found intracranial complication of CSOM. Continuous negligence of CSOM leads to various extracranial complications lethal intracranial complications like brain abscess, meningitis, etc. hence it is recommended that health education program should be provided as prevalence is still higher in younger age group and low socioeconomic class especially in rural and tribal regions. In spite of newer antibiotics, radiological modalities and surgical advancement. [ABSTRACT FROM AUTHOR]