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Hyper IgM syndrome (HIGM) is a rare primary immunodeficiency (PID) characterized by low IgG and IgA and normal or high IgM levels. The AICDA gene mutations lead to HIGM, the most prevalent autosomal recessive HIGM with intrinsic B cell defects. We present a patient with recurrent otitis media complicated by tympanic membrane perforation who was diagnosed with HIGM syndrome due to a novel mutation in the AICDA gene. Despite the fact that the symptoms began in early childhood, the patient was diagnosed seven years later, when complications developed. First-line immunological examination using serum immunoglobulin levels and antibody responses can rapidly detect antibody deficiencies. Keeping primary antibody deficiencies in mind in patients with recurrent sinopulmonary infections may contribute to an early diagnosis and prevention of complications. Being aware is the most important step in detecting PIDs. [ABSTRACT FROM AUTHOR]

Chronic mucosal otitis media is a very common ear disease for which patients attend otolaryngology clinics. Most of these patients present with actively discharging ears. This study aims to observe the middle ear space pathology and obtain surgical outcomes as a treatment for patients with advanced chronic mucosal otitis media with a transcanal endoscopic ear surgery approach. A prospective study was designed, and patients suffering from chronic mucosal otitis media in the active suppurative phase with an air-bone gap larger than 20 dB were included. 70 operated ears were included. Underlying macroscopic pathology within the middle ear space was observed: Middle ear granulomas at 58.6%; Tympanosclerosis 41.4%. Blockage of the tympanic isthmus was evaluated, obtaining a blockage rate of 81.4%. At 12 months of evaluation after surgery, a postoperative ABG < 20 dB was achieved in 85.7% of the operated ears. An overall closed tympanic membrane was obtained in 88.6% of the patients. This prospective cohort study shows the short-term efficacy of transcanal endoscopic type 3 tympanoplasty with mastoid preservation for managing advanced chronic mucosal otitis media. Clinical trials are required to give more evidence to the present matter. [ABSTRACT FROM AUTHOR]

The surgical outcomes following tympanic membrane (TM) repair are affected by many factors. To evaluate the efficacy of endoscopic porcine small intestine submucosa graft (PSISG) myringoplasty by comparing with endoscopic myringoplasty with temporal fascia (TF) and perichondrium (PC). We conducted a retrospective comparative study that a total of 98 patients with TM perforations were included. The patients underwent endoscopic myringoplasty using PSISG, TF or PC as the graft. The closure rate, hearing outcomes, operative time and complications in three groups were compared. At 3 months postoperatively, the closure rate were 85.2% (23/27), 92.1% (35/38) and 87.9% (29/33) in the PSISG, TF and PC groups respectively (p =.667); Hearing improved after surgery in three groups (p <.001), and showed no significant difference among the three groups. The mean operative time of the PSISG group was shorter than autologous TF (p <.001) and PC groups (p <.001) in this study; No operative or postoperative complications were found among the three groups. Compare to autologous temporal fascia or perichondrium, the PSISG appears to be an effective and safe material for TM perforations closure. Endoscopic PSISG myringoplasty may be an alternative technique for repairing TM perforations, especially for revision cases. [ABSTRACT FROM AUTHOR]

Background: The nasopharynx and middle ear are connected via the Eustachian tube. In infants and children, it is shorter, wider, and more horizontal, which explains why they have a higher risk of otitis media. The Eustachian tube controls pressure while ventilating, shielding, and draining the middle ear. The most crucial of these three tasks is pressure regulation. The tensor veli palatini muscle contracts during swallowing, jaw movements, and yawning, causing active intermittent openings of the Eustachian tube to allow the middle ear pressure (MEP) to acclimatize to air pressure. Inadequate tubal function causes the middle ear to experience negative pressure. Aim: The goal of the current study is to highlight the significance of adenoidectomy or adenotonsillectomy in improving Eustachian tube function and to determine how it affects MEP and hearing threshold. Methods and Materials: 50 patient attending ENT outpatient department of Late Shri Lakhiram Agarwal Memorial Government Medical College Raigarh, with symptoms and signs of chronic adenoiditis and/or adenotonsillitis, with or without features of chronic OME and undergoing adenoidectomy or adenotonsillectomy were included for the study. A prospective, experimental study was done after obtaining institutional ethical committee clearance. Relevant history was taken, and clinical examination was done to look for the presence of adenoid hypertrophy, tonsil hypertrophy, and also for the retraction or perforation of tympanic membrane (TM) and or presence of air-fluid level. X-ray Nasopharynx soft- tissue lateral view was done in all the cases to confirm the presence of adenoids. Results: The normal otoscopic findings was observed in 59.4% of ears examined. The air fluid level was observed in 25.2% of examined ears. Dull and retracted findings were observed in 18.7% of ears examined. The mean values of preoperative hearing threshold were 16.06 ± 9.204 dbHL. The mean values of 2nd postoperative hearing threshold were 20.60± 7.439 dbHL. The difference was statistically significant with p<0.001. The mean values of preoperative hearing threshold was 16.06 ± 9.204 dbHL. The mean values of 6th week postoperative hearing threshold was 8.70± 5.259 dbHL. The difference was statistically significant with p<0.001. The mean values of preoperative hearing threshold was 20.61 ±7.439 dbHL. The mean values of 6th week postoperative hearing threshold were 8.70± 5.259 dbHL. The difference was statistically significant with p<0.001. Conclusion: Early adenoidectomy or adenotonsillectomy will aid in the enhancement of the MEP and hearing threshold, the restoration of Eustachian tube function, and the prevention of OME's aftereffects. It may be thought of as a last choice because myringotomy with grommet insertion carries risks such otorrhea, irreversible perforation, scarring, and retraction. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of size and site of tympanic membrane perforation on the success of myringoplasty. Methodology: A cross-sectional, descriptive study was carried out from July 2019 to December 2021 in the ENT Department of Fauji Foundation Hospital Rawalpindi to achieve this objective. After approval of the Hospital Ethical Committee, a sample size of 100 patients was calculated by using the WHO sample size calculator. Patients were selected through Nonprobability convenient sampling. Informed consent was obtained from all the patients. All the patients were operated upon through a postauricular approach using the underlay technique and temporalis fascia was used as a graft in all the cases. The success of myringoplasty was assessed one month after surgery. Myringoplasty was considered successful upon complete closure of the defect as assessed under a surgical microscope. Data analysis was done using SPSS version 24. Qualitative variables like gender, site of perforation, size of perforation, and success rate were measured on frequency and percentage. Effect modifiers like age, gender, size of perforation, and site of perforation were controlled by the stratification. A chisquare test was employed and a p-value less than or equal to 0.05 was considered significant. Results: There were 52% males and 48% females. The mean age was 35.5 years and they ranged between 15 to 45 years. There were 46% of patients in group 15-25 years, while there were 54% of patients in group 26-45 years Overall myringoplasty was successful in 71% of patients. Myringoplasty was successful in 73% of males, while it was successful in 69% of females. It was successful in 93.5% of patients in the age group 15-25 years, while it was successful in 52% of patients in the age group 26-45 years. Regarding the size of perforation, it was successful in 100% pinhead size perforations, 86.7% small-sized, 89.5% medium-sized, 42% large, and 6.7% subtotal-sized perforations. Regarding the site of the perforations, myringoplasty was successful in 96% anterior, 100% posterior, 40% inferior, 40% central, and 8% subtotal/ large perforations. Conclusion: The success rate of myringoplasty has a definite association with size and site of perforation. The smaller the perforation, the higher would be the success rate. Similarly, anterior and posterior perforations heal better as compared to inferior and central perforations. [ABSTRACT FROM AUTHOR]

The significance of plasminogen activation during the tympanic membrane (TM) healing is known mainly from studies performed on knock-out mice. In the previous study, we reported activation of genes coding proteins of plasminogen activation and inhibition system in rat's TM perforation healing. The aim of the present study was the evaluation of protein products expressed by these genes and their tissue distribution using Western blotting and immunofluorescent method, respectively, during 10-day observation period after injury. Otomicroscopical and histological evaluation were employed to assess the healing process. The expression of urokinase plasminogen activator (uPA) and its receptor (uPAR) were significantly upregulated in the proliferation phase, with subsequent gradual attenuation during remodeling phase of healing process, when keratinocyte migration was weakening. The expression of plasminogen activator inhibitor type 1 (PAI-1) also showed the highest levels during the proliferation phase. The increase of tissue plasminogen activator (tPA) expression was observed during the whole observation period, with the highest activity during the remodeling phase. Immunofluorescence of these proteins was present mainly in migrating epithelium. Our study found that plasminogen activation (uPA, uPAR, tPA) and inhibitory (PAI-1) molecules form a well-structured regulatory system of the epithelial migration that is critical to the healing of TM after its perforation. [ABSTRACT FROM AUTHOR]

Objective: We aimed to compare the graft success rate and hearing outcomes in patients with large tympanic membrane (TM) perforation in underlay and over‐underlay approaches. Methods: This is a prospective double‐blind randomized controlled clinical trial with a parallel design. Patients aged 15–75 years old with large TM perforation (more than 50% of TM) who operated at Khalili hospital affiliated with Shiraz University of Medical Science, Iran, were enrolled. Exclusion criteria were recent otorrhea, revision surgery, and pathologic intraoperative findings such as the presence of cholesteatoma, cholesterol granuloma, ear canal polyp, or damaged ossicle. In the first group, the underlay method and in the second group over‐underlay method were performed. Graft success rate, atelectasis, and audiology outcomes were evaluated after 6 months. Results: The investigation was conducted on 84 patients in the underlay and 67 patients in the over‐underlay group. Although there was a higher rate of graft failure (9%) in the over‐underlay group in comparison with the underlay group (4.8%), the difference was not statistically significant (p‐value =.34). No atelectasis was seen in both group. Although, between‐groups comparison of the preoperative and postoperative speech reception thresholds (SRT) and air‐bone gaps (ABG) values showed statistically significantly lower SRT and ABG in the over‐underlay technique, the difference was clinically negligible. Conclusion: Both techniques provide the same graft success rate, but SRT and ABG were significantly lower in the over‐underlay technique after the operation. Levels of Evidence: 1b [ABSTRACT FROM AUTHOR]

Introduction: The study aims to evaluate the anatomical and functional success rates of endoscopic push-through cartilage myringoplasty for anterior tympanic membrane (TM) perforations. Materials and Methods: Thirty patients with TM perforations in the anterior quadrant underwent endoscopic push-through cartilage tympanoplasty and underwent prospective evaluation. The graft uptake rate and hearing gain were the outcomes evaluated. Results: Out of the 30 patients, 15 were male, and 15 were female. The mean age was 32.60 ± 13.66 years (from 18-60 years). The overall graft uptake rate was 90%, with failure observed in three cases. The mean preoperative air conduction threshold was 37.9 ± 5.83 dB which improved to 27.66 ± 4.88 dB at 16 weeks post-operation. The mean postoperative ABG closure was 7.28 dB with a p-value of 0.001 which was statistically significant. Conclusions: Endoscopic push-through cartilage myringoplasty is the least invasive, safe, simple, and advantageous for healing TM perforation and hearing restoration. [ABSTRACT FROM AUTHOR]

Objective: Management of tympanic membrane perforations is varied. This study aimed to better understand current practice patterns in myringoplasty and type 1 tympanoplasty. Methods: An electronic questionnaire was distributed to American Academy of Otolaryngology – Head and Neck Surgery members. Practice patterns were compared in terms of fellowship training, practice length, practice setting, paediatric case frequency and total cases per year. Results: Of the 321 respondents, most were comprehensive otolaryngologists (60.4 per cent), in private practice (60.8 per cent), with a primarily adult practice (59.8 per cent). Fellowship training was the factor most associated with significant variations in management, including pre-operative antibiotic usage (p = 0.019), contraindications (p < 0.001), approach to traumatic perforations (p < 0.001), use of local anaesthesia (p < 0.001), graft material (p < 0.001), tympanoplasty technique (p = 0.003), endoscopic assistance (p < 0.001) and timing of post-operative audiology evaluation (p = 0.003). Conclusion: Subspecialty training appears to be the main variable associated with significant differences in peri-operative decision-making for surgical repair of tympanic membrane perforations. [ABSTRACT FROM AUTHOR]

Objectives: To conduct a systematic review and meta-analysis of all randomized controlled trials (RCTs) that examined the efficacy of dry versus wet temporalis fascia graft among patients undergoing type-I tympanoplasty. Methods: Web of Science, Scopus, PubMed, and CENTRAL databases were screened from inception until July 2022. The Cochrane risk of bias tool was used to assess the quality of included RCTs. The outcomes were summarized as risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) in a random-effects model. Results: Eight RCTs with 989 patients (dry group = 514 and wet group = 475) were included. The overall quality was 'low', 'some concerns', and 'high' risk of bias in five, two, and one RCT(s), respectively. There were no significant differences between both groups regarding the surgical success rate (n = 8 RCTs, RR 0.99, 95% CI [0.95, 1.03], p = 0.6), audiological success rate (n = 5 RCTs, RR = 0.93, 95% CI [0.73, 1.13], p = 0.48), mean difference in pure tone average (n = 2 RCTs, MD = 2.73 Hz, 95% CI [− 2.31, 7.77], p = 0.29), and mean difference in graft placement time (n = 3 RCTs, MD = − 2.18 min, 95% CI [− 5.11, 0.76], p = 0.15). However, the mean difference in operative time was significantly lower in favor of the wet compared with the dry temporalis fascia group (n = 2 RCTs, MD = 2.95 min, 95% CI [− 1.80, 4.11], p < 0.001). The surgical success rate was not significantly different between both groups according to the tympanic membrane perforation size and site. Conclusions: The type of temporalis fascia graft (dry or wet) did not influence the clinical outcomes of type-I tympanoplasty. [ABSTRACT FROM AUTHOR]

Background: Tympanic membrane perforations (TMPs) are a common complication of trauma and infection. Persisting perforations result from the unique location of the tympanic membrane. The wound is surrounded by air of the middle ear and the external auditory canal. The inadequate wound bed, growth factor, and blood supply lead to circular epithelialization of the perforation's edge and premature interruption of defect closure. Orthotopic animal models use mechanical or chemical tympanic membrane laceration to identify bioactive wound dressings and overcome premature epithelialization. However, all orthotopic models essentially lack repetitive visualization of the biomaterial-wound interface. Therefore, recent progress in 3D printing of customized wound dressings has not yet been transferred to the unique wound setup of the TMP. Here, we present a novel application for the mice dorsal skinfold chamber (DSC) with an epithelialized full-thickness defect as TMP model. Methods: A circular 2-mm defect was cut into the extended dorsal skinfold using a biopsy punch. The skinfold was either perforated through both skin layers without prior preparation or perforated on 1 side, following resection of the opposing skin layer. In both groups, the wound was sealed with a coverslip or left unclosed (n = 4). All animals were examined for epithelialization of the edge (histology), size of the perforation (planimetry), neovascularization (repetitive intravital fluorescence microscopy), and inflammation (immunohistology). Results: The edge of the perforation was overgrown by the cornified squamous epithelium in all pre-parations. Reduction in the perforation's size was enhanced by application of a coverslip. Microsurgical preparation before biopsy punch perforation and sealing with a coverslip enabled repetitive high-quality intravital fluorescence microscopy. However, spontaneous reduction of the perforation occurred frequently. Therefore, the direct biopsy punch perforation without microsurgical preparation was favorable: spontaneous reduction did not occur throughout 21 days. Moreover, the visualization of the neovascularization was sufficient in intravital microscopy. Conclusions: The DSC full-thickness defect is a valuable supplement to orthotopic TMP models. Repetitive intravital microscopy of the epithelialized edge enables investigation of the underlying pathophysiology during the transition from the inflammation to the proliferation phase of wound healing. Using established analysis procedures, the present model provides an effective platform for the screening of bioactive materials and transferring progress in tissue engineering to the special conditions of tympanic membrane wound healing. [ABSTRACT FROM AUTHOR]

Introduction: Permanent perforation of the tympanic membrane occurring as sequelae of chronic suppurative otitis media is a major cause for deafness in India. Controversies range about every step of the operation from the incision to the material used for packing. Material and methods: Present study was conducted at Department of E.N.T., Tertiary Care Government Teaching Hospital. All the patients presenting with tympanic membrane perforation, of both sexes, of age group 12-55 years where tympanoplasty is advisable. Results: Association between follow up 6 months versus graft type was not significant. It was seen that graft uptake at 6 months was better in temporalis fascia graft compared to perichondrium with more graft intact rate and less residual perforation and no retraction. Conclusion: Success involved in tympanoplasties depend on various factors resulting in diverse outcomes in the studies comparing the success rates of the grafts. These factors include the number of patients included in the study, the surgical technique employed, the age of the patient, the size of the perforation in the tympanic membrane, the simultaneous interventions applied in the middle ear, co-morbid middle ear pathologies, and the duration of follow-up periods of the patients and also on experience of surgeon and advanced technologies and health care. [ABSTRACT FROM AUTHOR]

Intratympanic cholesteatoma (ITC) is a rare keratinous epithelial cyst of the tympanic membrane. A girl in her early childhood was referred to the otorhinolaryngology clinic following concerns about a pearly white mass in the pars tensa in the left ear. Enucleation of the lesion was performed under a general anaesthetic with a Rosen needle. A histological analysis confirmed cholesteatoma. A comprehensive assessment by an otolaryngologist is important in determining appropriate, timely surgical intervention and minimising complications such as tympanic membrane perforation and progression of cholesteatoma. [ABSTRACT FROM AUTHOR]

The article from the Canadian Medical Association Journal discusses sudden sensorineural hearing loss (SSNHL), which is defined as a rapid hearing loss of 30 decibels or more across 3 frequencies within 72 hours. It primarily affects individuals aged 40-60 and is often unilateral and idiopathic. Risk factors include smoking, alcohol consumption, diabetes, and hypertension, with symptoms such as tinnitus, aural fullness, and vertigo. Corticosteroids are the recommended first-line treatment, and the prognosis varies, with about 50% of patients experiencing some hearing recovery. Older age, severe hearing loss, and vertigo are associated with poorer outcomes. [Extracted from the article]

Purpose: The aim of this study was to compare the graft success rate, hearing outcome, and operative time in patients undergoing tympanoplasty for tympanic membrane perforation with the use of either biosynthetic or autologous graft material.This was a prospective randomized controlled trial performed at a regional hospital. 41 patients were enrolled and randomized, with 20 patients allocated to the treatment arm (biosynthetic graft) and 21 patients allocated to the control arm (autologous graft). The primary outcome was graft success rate. The secondary outcomes were operative time and hearing outcomes (assessed by pure tone audiogram hearing threshold improvement and closure of air-bone gap at 6 months postoperatively).There was no statistically significant difference in the graft success rate between the two groups (P = 0.645). There was also no statistically significant difference in the hearing outcomes (hearing thresholds improvement P = 0.886, air-bone gap improvement P = 0.651). However operative time was significantly shorter in the biosynthetic graft group compared with the autologous graft group (45.5 min vs. 72 min respectively; P < 0.001).This study demonstrates that tympanoplasty using a biosynthetic graft material can achieve comparable graft success rate and hearing outcomes as compared with conventional autologous graft tympanoplasty, but with the added benefits of a shortened operative time and avoiding incisions.Methods: The aim of this study was to compare the graft success rate, hearing outcome, and operative time in patients undergoing tympanoplasty for tympanic membrane perforation with the use of either biosynthetic or autologous graft material.This was a prospective randomized controlled trial performed at a regional hospital. 41 patients were enrolled and randomized, with 20 patients allocated to the treatment arm (biosynthetic graft) and 21 patients allocated to the control arm (autologous graft). The primary outcome was graft success rate. The secondary outcomes were operative time and hearing outcomes (assessed by pure tone audiogram hearing threshold improvement and closure of air-bone gap at 6 months postoperatively).There was no statistically significant difference in the graft success rate between the two groups (P = 0.645). There was also no statistically significant difference in the hearing outcomes (hearing thresholds improvement P = 0.886, air-bone gap improvement P = 0.651). However operative time was significantly shorter in the biosynthetic graft group compared with the autologous graft group (45.5 min vs. 72 min respectively; P < 0.001).This study demonstrates that tympanoplasty using a biosynthetic graft material can achieve comparable graft success rate and hearing outcomes as compared with conventional autologous graft tympanoplasty, but with the added benefits of a shortened operative time and avoiding incisions.Results: The aim of this study was to compare the graft success rate, hearing outcome, and operative time in patients undergoing tympanoplasty for tympanic membrane perforation with the use of either biosynthetic or autologous graft material.This was a prospective randomized controlled trial performed at a regional hospital. 41 patients were enrolled and randomized, with 20 patients allocated to the treatment arm (biosynthetic graft) and 21 patients allocated to the control arm (autologous graft). The primary outcome was graft success rate. The secondary outcomes were operative time and hearing outcomes (assessed by pure tone audiogram hearing threshold improvement and closure of air-bone gap at 6 months postoperatively).There was no statistically significant difference in the graft success rate between the two groups (P = 0.645). There was also no statistically significant difference in the hearing outcomes (hearing thresholds improvement P = 0.886, air-bone gap improvement P = 0.651). However operative time was significantly shorter in the biosynthetic graft group compared with the autologous graft group (45.5 min vs. 72 min respectively; P < 0.001).This study demonstrates that tympanoplasty using a biosynthetic graft material can achieve comparable graft success rate and hearing outcomes as compared with conventional autologous graft tympanoplasty, but with the added benefits of a shortened operative time and avoiding incisions.Conclusion: The aim of this study was to compare the graft success rate, hearing outcome, and operative time in patients undergoing tympanoplasty for tympanic membrane perforation with the use of either biosynthetic or autologous graft material.This was a prospective randomized controlled trial performed at a regional hospital. 41 patients were enrolled and randomized, with 20 patients allocated to the treatment arm (biosynthetic graft) and 21 patients allocated to the control arm (autologous graft). The primary outcome was graft success rate. The secondary outcomes were operative time and hearing outcomes (assessed by pure tone audiogram hearing threshold improvement and closure of air-bone gap at 6 months postoperatively).There was no statistically significant difference in the graft success rate between the two groups (P = 0.645). There was also no statistically significant difference in the hearing outcomes (hearing thresholds improvement P = 0.886, air-bone gap improvement P = 0.651). However operative time was significantly shorter in the biosynthetic graft group compared with the autologous graft group (45.5 min vs. 72 min respectively; P < 0.001).This study demonstrates that tympanoplasty using a biosynthetic graft material can achieve comparable graft success rate and hearing outcomes as compared with conventional autologous graft tympanoplasty, but with the added benefits of a shortened operative time and avoiding incisions. [ABSTRACT FROM AUTHOR]

Robotic gynecologic surgery is associated with the use of steep Trendelenburg positioning. Steep Trendelenburg is necessary to provide optimal exposure to the pelvis but is associated with an increased risk of non-surgical complications such as suboptimal ventilation, facial and laryngeal edema, increased intraocular and intracranial pressure as well as neurologic injury. Several case reports have described otorrhagia after robotic assisted surgery; however, there are limited reports on the risk of tympanic membrane perforation. To our knowledge, there are no published reports on tympanic membrane perforation in gynecologic nor gynecologic oncology surgery. We report two cases of perioperative tympanic membrane rupture and bloody otorrhagia associated with robot-assisted gynecologic surgery. In both cases otolaryngology/Ear Nose and Throat (ENT) was consulted, and the perforations resolved with conservative management.

Introduction: Repair of anterior perforation of the tympanic membrane is difficult mainly due to inadequate exposure, minimal tympanic membrane remnant, impaired vascular supply, and delayed healing. Methods: This analytical cross-sectional study was done in a tertiary center over a period of 12 months from 25 April 2021 to 24 April 2022. There were 47 patients who underwent endoscopic transcanal type I cartilage tympanoplasty for anterior perforation. All operations were performed using an underlay technique and by transcanal approach. In all the cases, perichondrium with tragal cartilage was used as a graft for the reconstruction of the tympanic membrane. The evaluation was done after three months post-operatively in terms of graft uptake and post-operative hearing status. Results: The overall graft uptake success rate after three months post-operatively was 89.4%. The pre-operative mean pure-tone average was 34.72 ± 6.45 dB, (range 17 dB to 43 dB). The mean postoperative pure-tone average was 22.09 dB ± 9.30 (range 10 to 41 dB). The mean difference between the preoperative pure tone average and the postoperative pure tone average was 12.63 dB ± 8.96 (p < 0.05). The mean preoperative air-bone gap average was 23.38 dB ±7.98 (range 6 to 40 dB) and the mean postoperative air-bone gap of 13.45 ± 6.89 (range 5 to 32 dB). This resulted in improvement in the air-bone gap by 9.93 dB (p < 0.05). Conclusion: Endoscopic transcanal tympanoplasty is a minimally invasive procedure, which provides complete exposure of anterior tympanic membrane perforation thus avoiding external incisions and canaloplasty.

The aim of this study was to comparative analysis of the auditory function of the ear before and after surgical treatment of tympanosclerosis. Study of the clinical and audiological conditions of patients with tympanosclerosis. During the examination from December 2021 to May 2022 (6 months), 27 patients with tympanosclerosis were examined. The patients underwent the following examinations: general ENT examination (otoendoscopy, otomicroscopy), audiometry, multislice computed tomography of the temporal bones. According to the results of the above studies, all examined patients were conditionally divided into 3 groups. Due to the absence of perforation of the tympanic membrane and hearing loss in patients of I group, dynamic monitoring of patients was proposed. Patients of II group were offered surgical treatment. During the operation, the tympanic cavity of the patients was cleaned from tympanosclerotic plaques, the handle of the malleus and the rest of the tympanic membrane. The mobility of the auditory ossicles after the removal of the plaques was completely restored. Patients of III group were also recommended surgical treatment. During the operation, tympanosclerotic plaques were removed from the tympanic cavity and around the auditory ossicles. Except the tympanoplasty to the patients who had non-restoration of movements of ossicles were used prosthesis PORP or TORP. If in such cases fixation of the malleus and anvil of the bones is observed, it is necessary to remove the head of the malleus and incus, if the movement of the stirrup is not restored in these patients, it is indicated to prepare for the operation a secondary total ossiculoplasty. [ABSTRACT FROM AUTHOR]

Evidence suggests that otologic injury from ototopical aminoglycoside preparations is infrequent when used to treat ear infections with an intact tympanic membrane. Meanwhile, parenteral administration of aminoglycosides, is well known to be associated with a significant incidence of cochlear and vestibular damage. The discrepancy between topical and parenteral ototoxic effects is thought to result from a combination of factors, including the protective function of debris overlying the round window membrane, low antibiotic concentrations of topical antibiotic preparations, length of exposure and inability to detect subtle hearing or vestibular changes. Herein, we present a case of acute vestibulopathy following a 2-week course of topical gentamicin otic drops. Awareness of vestibulotoxicity following topical gentamicin therapy is prudent as vestibulopathic symptoms can be severely debilitating. [ABSTRACT FROM AUTHOR]

Background: Intratympanic membrane cholesteatoma presents as an asymptomatic, white, round mass on the tympanic membrane, and is usually detected incidentally in children. Case presentation: A 12-year-old Korean boy visited our otorhinolaryngology clinic for a whitish mass on the right tympanic membrane. He had a history of traumatic tympanic membrane perforation in the right ear that had occurred 1 year prior, which had healed well with a paper patch placement. The mass was completely removed under local anesthesia during surgery with a microscope. The mass was on the outer epithelial layer of the right tympanic membrane and did not invade the middle fibrous and inner mucosal layers. Cholesteatoma was diagnosed on the basis of histopathology. Conclusion: Intratympanic membrane cholesteatoma may not induce symptoms or invade the middle ear because it can grow outwards into the external auditory canal. However, intratympanic membrane cholesteatoma can grow over time, and then after growth, it can compress the tympanic membrane and advance into the middle ear, which can cause symptoms such as hearing loss. Intratympanic membrane cholesteatoma in children should be carefully evaluated and followed, and surgical removal should be considered, even for asymptomatic cases, to minimize potential damage and hearing loss. [ABSTRACT FROM AUTHOR]

Introduction: The number of migrants living in Europe is growing rapidly. The PROTECT project is a national study conducted among refugees and migrants in the Lazio region, Italy from February 2018 to September 2021 to evaluate their otolaryngological, dental, and ophthalmic health status. This article reports the results of this study with a special focus on otolaryngological conditions and diseases. Materials and methods: A total of 3023 participants were included in the project. Data on the participants' demographic factors, migration status, and otolaryngological history were collected using a questionnaire. Each patient underwent clinical ear, nose, and throat examination, and the main otolaryngological conditions and diseases were noted. Results: nearly two-thirds of participants were males (68.1%). The mean age was 31.6 ± 13.1. Most of the participants were born in Nigeria, followed by Bangladesh, Pakistan, Somalia, Mali, and Gambia. The prevalence of chronic noise exposure was 5.2%. Unilateral hearing loss was reported by 6.5% of the subjects, and bilateral hearing loss by 3.6%. The most frequent symptoms reported in the questionnaire were snoring (10.4%), nasal obstruction (5.9%), vertigo (5.0%), otalgia (4.5%), and tinnitus (4.2%). At the clinical examination, the most frequent findings were nasal septum deviation (25.2%), ear wax (6.5%), hypertrophic palatine tonsils (5.3%), and tympanic membrane perforation (1.3%). Conclusions: the PROTECT project allowed for the evaluation of otolaryngological, dental, and ophthalmological conditions in over 3000 migrants, giving them the possibility to access specialist care. [ABSTRACT FROM AUTHOR]

A number of studies have produced normative and developmental data and examples of wideband acoustic immittance (WAI) obtained in ears with pathologies and or dysfunction. However, incorporation of this tool into clinical audiology and otolaryngology practice has been slower than expected, potentially due to challenges with interpretation, integration into existing test batteries, and confidence in practical application. This article presents information aimed at helping clinicians increase their confidence in using this new tool by becoming more familiar and making connections with the ways that WAI outcomes both align with and add to standard immittance, audiometric and otologic diagnostic test outcomes. This article presents several case studies to demonstrate the use of WAI in realistic clinical settings. Each case presents a brief background, case history, audiologic/otologic findings, and initial recommendations, followed by a discussion on how the inclusion of WAI test outcomes aids in diagnostic decisions. The overall aim of this work is to identify the relationships among different diagnostic test outcomes, to demonstrate basic WAI interpretation principles, and encourage the reader to engage with this diagnostic tool in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Over the past century, numerous methods have been used to image the Eustachian tube, but none of them have gained widespread acceptance. Patients with persistent Eustachian tube dysfunction now have an increased need to have their Eustachian tubes examined, thanks to the discovery of balloon Eustachian tuboplasty (BET). Prior to BET, a lot of facilities perform temporal bone and epipharynx computed tomography (CT) scans. Aim: The aim of our study was to review measures of patency of ET and delineate its interior luminal anatomy in patients with tympanic membrane perforation subjected for myringoplasty in an objective radiologic way by injecting a radiopaque dye into tympanic orifice of ET through TM perforation and tracing it with high resolution computerized tomography scan. Conclusion: It is possible and safe to visualize the ET lumen in people using intratympanic contrast media, and doing so during a preoperative CT scan does not cover up other important image data. [ABSTRACT FROM AUTHOR]

Background: Tympanic membrane perforation (TMP) is a common disease in otology, and few acellular techniques have been reported for repairing this condition. Decellularized extracellular matrix (ECM) scaffolds have been used in organ reconstruction. Objective: This study on tissue engineering aimed to develop a tympanic membrane (TM) scaffold prepared using detergent immersion and bone marrow mesenchymal stem cells (BMSCs) as repair materials to reconstruct the TM. Results: General structure was observed that the decellularized TM scaffold with BMSCs retained the original intact anatomical ECM structure, with no cell residue, as observed using scanning electron microscopy (SEM), and exhibited low immunogenicity. Therefore, we seeded the decellularized TM scaffold with BMSCs for recellularization. Histology and eosin staining, SEM and immunofluorescence in vivo showed that the recellularized TM patch had a natural ultrastructure and was suitable for the migration and proliferation of BMSCs. The auditory brainstem response (ABR) evaluated after recellularized TM patch repair was slightly higher than that of the normal TM, but the difference was not significant. Conclusion: The synthetic ECM scaffold provides temporary physical support for the three‐dimensional growth of cells during the tissue developmental stage. The scaffold stimulates cells to secrete their own ECM required for tissue regeneration. The recellularized TM patch shows potential as a natural, ultrastructure biological material for TM reconstruction. [ABSTRACT FROM AUTHOR]

Background: Tympanic membrane perforation repair methods are available in a variety of types and can typically be categorised as underlay or overlay grafting methods. Each approach has a specific use, benefits, and challenges. Objective: Evaluation of hearing level and closure of the tympanic membrane by the graft after endoscopic notched thinned tragal chondroperichondrial graft myringoplasty with no need to elevate the tympanomeatal flap for repair of central and marginal perforations. Patients and Methods: A total of 30 participants with medium-sized central or marginal posterior perforations were included. done for them endoscopically assisted with notched thinned tragal chondroperichondrial myringoplasty was done for them. Measurements of hearing level and attachment rate of the graft after six months from the surgery, then again nine months later on. Results: At six months, the take rate of the graft together with complete closure of the perforation was 96.7% (29/30), but after nine months, it was 93.3% (28/30). One patient experienced anterior annulus lateralization in addition to extrusion, and there was still evidence of perforation. 2 patients had acute otitis media at the same side of surgery resulting in a perforation. The mean preoperative gap between air and bone conduction (27.62 ± 3.15 dB) was more significant than the mean air-bone gap postoperatively (12.16 ± 3.01 dB; P < 0 .05) at six months. However, there was no statistically significant difference in the functional success rate (P 14.472), air-bone gap (ABG) levels (P 14.877), or ABG gain (P 14 0.748) between the post-6 months or post-9 months. Conclusion: Endoscopic notched thinned chondroperichondrial graft myringoplasty with no need to elevate the myringomeatal flap is ideal for repairing central perforations. With minimally invasive technology. The long-term success rate of the graft is as high as the short-term success rate, and the hearing results are promising. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to assess the double-layer temporalis fascia grafting for myringoplasty for subtotal tympanic membrane (TM) perforation regarding graft uptake and hearing gain. Patients and Methods: The study included 60 patients with subtotal TM perforation attributed to tubotympanic suppurative otitis media. Myringoplasty was done through a postauricular approach using the underlay technique by two layers of the temporalis fascia grafts in the study group and one layer of the temporalis fascia graft in the control group. The procedure was considered successful if there was no residual TM perforation within the follow-up period. Results: Within included 60 patients, 30 patients in the study included 60 patients, 30 patients in the study group (11 males and 19 females) and 30 patients in the control group (9 males and 21 females). The success rate of TM healing was 100% in the case group and 87.7% in the control group with significant difference (P = 0.038). The hearing gains (>10 dB) were reported in 96.7% in the case group while it was 70% in the control group which is significantly better (P = 0.00558). Conclusion: The double-layer temporalis fascia graft is effective for both postoperative graft taking and hearing improvement for subtotal (Grade 4) TM perforation. [ABSTRACT FROM AUTHOR]

Non-consecutive patients, undergoing tympanoplasty type I with tragal perichondrium graft were randomly selected for reimplantation of perichondrium peeled tragal cartilage at the time of surgery (Figure 1). The objectives of follow-up were to track tympanic membrane healing, detect recurrence of tympanic membrane perforation (regardless of its cause), and evaluate tragus wound healing for signs of cartilage infection or extrusion. Keywords: endoscopy; tragus; tympanic membrane perforation; tympanoplasty EN endoscopy tragus tympanic membrane perforation tympanoplasty 75 78 4 12/16/22 20230101 NES 230101 Key Points Tragal perichondrium is employed in endoscopic transcanal tympanoplasty, although the tragal cartilage is frequently discarded once the perichondrium is harvested. [Extracted from the article]

Purpose: The purpose of this study was to compare the effectiveness of endoscopic and microscopic approaches for butterfly cartilage graft inlay tympanoplasty regarding anatomical and hearing outcomes through a systematic review and meta-analysis. Methods: A search of PubMed, Embase, MEDLINE, and Virtual Health Library was performed from inception to July 3rd, 2021, using keywords, such as tympanoplasty, cartilage graft, and inlay technique. Data from articles that met inclusion criteria were extracted by two authors independently. The PRISMA statement was followed. RoB-2 and ROBINS-I tools were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air–bone gap. Results: Five studies were included, one randomized clinical trial and four retrospective cohorts, in which a total of 318 patients were included. Graft take rate was 91.3% in the endoscopic group and 93.6% in the microscopic group (RR 0.98; 95% CI 0.93–1.03; I2 0%; P = 0.68). Four studies provided data about the secondary outcome, all showing significant reductions in air–bone gap, ranging from 5.7 to 11.0 in the endoscope group and from 5.8 to 11.6 in the microscope group, with a mean difference between groups of 0.85 (95% CI − 0.79 to 2.48). Conclusion: Although the overall evidence of the included studies was low, endoscopic and microscopic butterfly cartilage graft inlay tympanoplasties have similar results on anatomical and hearing outcomes, making the selection between such approaches an individual choice for the surgeon. [ABSTRACT FROM AUTHOR]

Introduction Type I Tympanoplasty is a common ear surgery performed in Nepalese children, but no studies have been published about the success rate of the procedure and the factors affecting surgical outcomes. Objectives To find out the surgical outcome of type I tympanoplasty and to evaluate the factors affecting the success of the surgery in Nepalese children. Methods This is a retrospective study conducted by analyzing the medical records of a five-year period. Children aged 8-16 years who underwent type I tympanoplasty were included in the study. Surgical pro-forma and records of pre and post-operative pure tone audiometry were documented. Outcome of the surgery was considered a success in terms of graft uptake and hearing improvement six months after surgery. Results Out of 629 children who underwent type I tympanoplasty, anatomical success was observed in 93.32% (n = 587) and functional success in 76% (n = 478). Factors such as age, site and size of the perforation, status of the middle ear and contralateral ear, surgical approach, and the graft used were not the predictors of the surgical outcome. Conclusions The surgical outcome of type I tympanoplasty in Nepalese children was good. Although surgical outcome was better with older children, post-aural approach, temporalis fascia, inferiorly positioned perforations, and in children with dry middle ear mucosa, none of the parameters considered in this study were found to be a significant predictive factor of the surgical outcome. [ABSTRACT FROM AUTHOR]

INTRODUCTION Traumatic tympanic membrane perforation is the most common type of trauma – induced otologic dysfunction. The study is aimed to evaluate factors affecting healing of truamatic tympanic membrane perforation after 12 weeks. MATERIAL AND METHODS A prospective observational study conducted at UCMS, Bhairahawa, Nepal. Sixty patients with traumatic tympanic membrane perforation were evaluated on the basis of causes of trauma, symptoms, otoscopic examination, size of perforation and other factors affecting the outcome of perforation. Healing status of tympanic membrane was assessed 12-week post injury. RESULTS The age of the patients ranged from 4-79 years with mean age (years) of 27.84 ± 13.16. Otalgia was seen in 36 (60%) followed by hearing loss 21 (35%) and least common was vertigo 2 (3%). Most common etiology for injury was ‘Slap’(30%) followed by fall injury and physical assault excluding slap with each comprising 16%. Number of patients with small, medium and large perforations were 27 (45%), 21 (35%) and 12 (20%) respectively. After 12 weeks, 46 (77%) cases had healed perforation with best healing seen in younger patients having age group 11-40 years (26.28±13.5) and least in age group >60 years (52±25.11 ) with p value of 0.01. 97% cases of smaller perforation had healed tympanic membrane whereas in larger perforation healing was observed in only 42 % cases. CONCLUSION Age, size of perforation, types of traumas have significant effect on outcomes of spontaneous healing. With cautious care and strong aural precautions, the prognosis of tympanic membrane perforation spontaneous healing is favourable. [ABSTRACT FROM AUTHOR]

Background and Objectives: Non-autologous graft materials hold promise for tympanic membrane (TM) perforation closure. In the present manuscript, we aimed to evaluate the influence of clinical and surgical (i.e., graft materials) characteristics on tympanoplasty outcome in chronic otitis media (COM). Materials and Methods: We retrospectively reviewed clinical and surgical characteristics of COM patients with TM perforation treated with tympanoplasty and mastoidectomy. Univariate and multivariate appropriate tests were applied. Results: We used xenograft (porcine submucosal collagen) in 163 patients, and temporalis fascia in 210. The mean follow-up time was 37.2 months. Postoperative TM perforation (i.e., negative outcome) was detected in 11.6% of cases with xenograft, and in 12.8% with temporalis fascia. Performing uni- and multivariate analysis, we determined that large (three or all quadrants) TM perforation (p = 0.04) and moderate-to-severe intraoperative bleeding (p = 0.03) were independent prognostic factors of negative outcome. Considering the 197 patients with moderate-to-severe intraoperative bleeding, we disclosed that the use of temporalis fascia (p = 0.03) was an independent risk factor of postoperative TM perforation. Conclusions: According to our results, large TM perforation and moderate-to-severe intraoperative bleeding were independent prognostic factors of negative outcome in adult COM patients treated with tympanoplasty. In the sub-group of COM patients with excessive intraoperative bleeding, use of temporalis fascia was associated with negative outcome; these patients could benefit from xenograft materials. These findings should be tested in large randomized clinical trials. [ABSTRACT FROM AUTHOR]

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Background: Bullous pemphigoid is the most common autoimmune subepidermal blistering disorder with a low incidence in childhood. Combined immunodeficiencies (CIDs) are a group of monogenic inborn errors of immunity (IEIs) characterized by T- and B-cell dysfunction leading to recurrent infections, lymphoproliferation, predisposition to malignancy, and autoimmunity. Here, we report two Afghan siblings with a diagnosis of CID and extremely rare manifestation of diffuse bullous pemphigoid skin lesions. Case presentation: The older sibling (patient 1) was a 32-month-old male with facial dysmorphism, protracted diarrhea, failure to thrive, recurrent oral candidiasis, recurrent otitis media with tympanic membrane perforation, who had been previously diagnosed with CID. While he was under treatment with intravenous immunoglobulin (IVIg), he developed extensive blistering lesions, which were diagnosed as childhood bullous pemphigoid. Methylprednisolone and azathioprine were added to the regimen, which resulted in a remarkable improvement of the skin lesions and also the feeding condition. However,2 weeks later, he was re-admitted to the intensive care unit (ICU) and eventually died due to fulminant sepsis. Later, his 12-month-old sister (patient 2) with similar facial dysmorphism and a history of developmental delay, food allergy, recurrent oral candidiasis, and respiratory tract infections also developed blistering skin lesions. She was under treatment for occasional eczematous lesions, and had been receiving IVIg for 3 months due to low levels of immunoglobulins. Further immunologic workup showed an underlying CID and thus treatment with IVIg continued, gradually improving her clinical condition. The genetic study of both siblings revealed a novel homozygous mutation in exon 7 of the PGM3 gene, c.845 T > C (p.Val282Ala). Conclusions: Dermatologic disorders may be the presenting sign in patients with CID and mutated PGM3. This case report further extends the spectrum of skin manifestations that could be observed in PGM3 deficiency and emphasizes the importance of considering CIDs during the assessment of skin disorders, particularly if they are extensive, recurrent, refractory to treatment, and/or associated with other signs of IEIs. [ABSTRACT FROM AUTHOR]

Aspergillus otomastoiditis are extremely rare, even in immunocompromised patients. We report a case of a 32-year-old immunocompetent female, who underwent a tymanoplasty because of foul smelling purulent discharge since childhood with congenital cholesteatoma and attic type of perforation in the tympanic membrane. The facial nerve was not involved. Histopathology yielded cholesteatoma sac with Aspergillus colonies. This patient's age seems to be younger as per other cases reported. Aspergillus otomastoiditis involving the external auditory canal is again a rarity. When confronted with otitis/ear complaints with an unexpected clinical course a high index of suspicion is required to facilitate early diagnosis and appropriate therapy of a possible lethal Aspergillus infection, even in immunocompetent patients. [ABSTRACT FROM AUTHOR]

Background: Middle ear disease is common in children and, if untreated, can lead to long term complications. This study investigated whether ethnic or socioeconomic inequities existed among children referred to a tertiary regional paediatric ORL service. Methods: All middle ear pathology related referrals to Starship Children's Hospital ORL service during 2018 and 2019 were reviewed. Online clinical records were accessed to collect demographic data and appointment outcomes. The relationships between ethnicity, socioeconomic status, age at referral and clinic attendance were analysed. Results: A total of 1530 children were referred and 214 (14.0%) of these did not attend their scheduled appointments. Compared with the age of referral for European children, Māori children were referred on average 1.1 years older while Pasifika children were referred 2.4 years older. Compared to European children, Māori children were 4.3 times more likely to miss an appointment while Pasifika were 7.2 times more likely. Socioeconomic status had no significant effect on either age of referral or clinic attendance. Conclusions: Māori and Pasifika children with middle ear disease are referred later and are more likely to miss outpatient clinic appointments. Pasifika children are affected more than Māori. [ABSTRACT FROM AUTHOR]

In fat myringoplasty, fat harvested from ear lobule is used as graft material for the closure of small size central perforation of tympanic membrane under local anaesthesia. This study was performed over a period of 5 years (January 2016–December 2020) on 67 cases who underwent surgery and were willing to participate in the study at our tertiary hospital. Closure of perforation was found in 93% of cases within 2–3 months of surgery. Hearing gain was 6.8 dB on an average and morbidity was insignificant in successful cases. Fat myringoplasty is a successful yet simple procedure for repair of small size perforations. It is a day-care procedure under local anaesthesia requiring minimal tissue handling. It is also cost effective and has minimum post-operative morbidity. The likely cause of failure are ear infections and graft displacement due to respiratory tract infections. Results of the fat myringoplasty also depend upon the experience of the operating surgeon and cooperation of the patient. [ABSTRACT FROM AUTHOR]

The purpose of the study is to investigate how Collagen sheet used as graft material in Myringoplasty improves hearing and tympanic membrane tissue repair in patients with tympanic membrane perforation (TMP) in an office based procedure. Total 50 cases included in the study where Collagen sheet used as graft material for myringoplasty in small to moderate size tympanic membrane perforations(TMP) and procedure performed in an office based set up with the help of a High definition endoscope and camera. Cases followed up regularly and results observed in terms of graft uptake and complete closure of TMP and hearing improvement. Out of 50, complete closure of TMP observed in 39 cases and an average hearing gain of 9.9 db noted in these cases. Success rate of 78% achieved and failed cases were subjected to traditional post auricular method of myringoplasty under microscopic guidance. Myringoplasty with the help of collagen sheet material in an office based set up is an easy, minimally invasive and effective technique and it avoids need for major invasive intervention in a significant number of patients. [ABSTRACT FROM AUTHOR]

The objective of the study was to assess the effect of size & site of tympanic membrane perforation on hearing loss. The study was carried out in ENT department of a tertiary health care hospital, between October 2018 and March 2020 (a total of 18 months). Patients aged 15–50 years having chronic otitis media with dry central perforation were included in the study after taking informed written consent and were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for Tympanoplasty and just prior to the procedure, the tympanic membrane perforation size was measured using the Castroviejo caliper and site was noted using otomicroscopy. The status of the middle ear mucosa and ossicles were also analyzed to ensure normal middle ear mucosa and normal ossicular mobility and continuity and only then were these patients included in the study. All the patients in the study were evaluated for hearing loss using air conduction measurements in pure tone audiometry done at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz and 4000 Hz. Hearing loss was found to be directly proportional to the size of perforation in our study. The site of the perforation has a significant association with the degree of hearing loss. Those perforations with posterior quadrant involvement and multiple quadrant involvement had a higher hearing loss. From our study, we concluded that there is a significant relationship between size and site of the perforation and the amount of hearing loss. [ABSTRACT FROM AUTHOR]

Tympanoplasty is a surgical procedure which includes eradication of disease from the middle ear and reconstruction of the hearing mechanism with or without tympanic membrane repair. The purpose of this article was to compare the clinical and audiological outcomes of Type 1 underlay tympanoplasty with or without anterior tucking of the temporals fascia graft. This is a prospective interventional study which included 100 patients between 15 and 60 years of age, diagnosed with chronic otitis media, mucosal disease inactive stage. 100 patients were divided into two groups 50 each, who underwent type 1 underlay tympanoplasty, group A underwent anterior tucking of the temporals fascia graft and group B without anterior tucking of the temporals fascia graft. Analysis of data was made of the demographic details, graft uptake status and audiological outcomes following surgery. Among the 100 patients included in the study, majority were seen between 21 and 40 years of age group. In our study successful graft uptake was seen in 93.4% in group A temporalis fascia with anterior tucking which was better than group B which showed 84% results. However hearing outcome was almost similar in both the groups. In conclusion, graft uptake in tympanoplasty with anterior tucking was found to be better than without anterior tucking. There is significant hearing improvement following underlay technique of tympanoplasty both with and without anterior tucking. There is no significant difference in the hearing improvement with anterior tucking when compared to without anterior tucking of the temporalis fascia graft. [ABSTRACT FROM AUTHOR]

Platelet-rich plasma (PRP) is a reliable and has low side-effect profile and has beneficial effects on wound healing. Its investigatory effects on wound-healing process were shown on various tissues. This study aims to investigate PRP's local application effects to perforated rat TM in terms of healing and histopatological outcomes. Twenty-two Wistar rats were used in the study. The rats' ears were examined with a pediatric endoscope (2.7 mm, 0°), and the TM posterior quadrant of their right ear was perforated with a 20-gauge needle. After this procedure, the rats were divided into two equal groups. A spongel with PRP was applied on the perforated TM in the first group, and spongel with standard saline solution was applied on the second group. Following the sacrifice, the middle air bullas were carefully dissected and removed for histopathological examination. Hematoxylin eosin (for fibroblasts, lymphocyte, collagen fibers) and immunohistochemical staining were done for epithelial growth factor receptor (EGFR), fibroblast growth factor receptor (FGFR1), and vascular endothelial growth factor (VEGF) staining for histopathologic examinations. There was not a significant difference between the two groups for lymphocyte. There was a significant difference between control and study groups for collagen and EGFR (P < 0.05). Although the mean value of FGF- and VEGF-positive cells was higher in the study group than in the control group, the difference was not significant (P > 0.05). PRP is an effective autologous material for the healing process of acute TM perforations in a rat model, as demonstrated in the present study. We think that the use of PRP for acute TM perforations can have a positive effect on the healing process by increasing the level of growth factors, especially EGFR. In addition, an increase in collagen can also have a positive effect on healing. [ABSTRACT FROM AUTHOR]

One of the most common problems in otorhinolaryngology is perforation of tympanic membrane. Although many small perforations heal spontaneously over time, some may remain persistent due to infection or some other causes. In the past years so many grafts have been used with good success rate. In this prospective study of 60 patients with small tympanic membrane perforations, we have compared newer biomaterial collagen patch and conventional fat plug as office procedures in treatment. According to our study, both groups had a significantly equal success rates & the rate of healing & complete closure at the end of 1 & 2 months follow up. The hearing improvement in A-B gap during follow up of both groups were compared with pre-op A-B gap & showed a significant p value. This showed that both collagen patch & fat plug groups had a significant improvement in hearing following procedure. In our study quadrant of perforation does not correlate with the amount of hearing & healing rates were comparatively better in anterior quadrant than posterior quadrant. Infective causes were more & the failure rates were also high for such cause in both groups. [ABSTRACT FROM AUTHOR]

Chronic otitis media is a disease developing due to Eustachian tube dysfunction secondary to any insult in nasopharynx which is likely to be bilateral with different stages of disease in both ear. The objective of this study was to examine contralateral ear through otoscopic, radiological and audiological study. Study was conducted between December 2018 and July 2020 in Otorhinolaryngology and Head and Neck Suregery Department. The Contralateral ear was defined as the ear with no tympanic membrane perforation and with no symptoms in patients of unilateral chronic otitis media. Otoscopy, Pure tone audiometry and HRCT temporal bone were done. Results were recorded and analysed. Descriptive stastical analysis was done using SPSS software version 22 of Windows 7. Grade1 pars tensa retraction which is most common abnormal finding in contralateral ear on otoscopy in both unilateral mucosal and squamosal COM patients. On otoscopy of contralateral ear 71.43% squamosal COM patients were having abnormal tympanic membrane. Hearing loss was seen in 25.71% patients of mucosal COM and 22.9% patients of squamosal COM patients. 17.1% patients of mucosal COM and 20% patients of squamosal COM show mastoid sclerosis of contralateral ear on HRCT temporal bone. Majority of patients with unilateral COM have initial findings of pathogenesis of COM in contalateral ear. These findings in contralateral ear are more common in patients with squamosal COM than patients with mucosal COM [ABSTRACT FROM AUTHOR]

This study aims to compare the graft success and hearing results of the palisade and island cartilage graft, with wheel-shaped composite cartilage graft (WsCCG) for type 1 tympanoplasty. The study was designed retrospectively. Only patients with conductive hearing loss and simple pars tensa perforation of the tympanic membrane were included in the study. Pure tone average (PTA), air–bone gap gain (ABG), word recognition score (WRS), ABG closure and grafts success were compared between the graft groups. Records of 111 patients were analyzed. The graft success rate was 89.7% for palisade cartilage graft (PCG, n = 39), 86.1% for island cartilage graft (ICG, n = 36), and 97.2% for wheel-shaped composite cartilage graft (WsCCG, n = 36) (p = 0.244). Average postoperative PTA and ABG values were significantly affected by the cartilage graft type, but WRS was not affected. (p = 0.005, 0.019, 0.306, respectively, One Way-Anova test). Post-Hoc LSD test showed a statistically significant decrease in PTA and ABG averages for WsCCG group compared to the ICG group (p = 0.004; CI%95 = 15.1–2.2 dB and p = 0.023; CI%95 = 8.2–0.4 dB, respectively). Postoperative PTA and ABG averages for WsCCG and PCG groups were similar (p = 0.069 and p = 0.053, respectively). In addition, while there were 2 (5.1%) retractions in the PCG group and 1 (2.7%)in the ICG group, there was no retraction in the WsCCG group. The WsCCG provided comparable results with classical reliable graft techniques (PCG and ICG) and may recommend as a more suitable graft due to hearing results and resistance against retraction. [ABSTRACT FROM AUTHOR]

The preoperative and postoperative pure-tone hearing thresholds and anatomical graft success of pediatric patients who underwent chronic otitis mediasurgery with various indications were evaluated and the factors affecting success were examined.Pediatric patients aged 6 to 18 years, who underwent ear surgery for various reasons between January 1, 2013 and January 1, 2020 were included in the study. All patients included in the sample were assessed in terms of age (< 13 and ≥ 13 years), disease type (cholesteatoma, tympanosclerosis, adhesive otitis media, chronic suppurative otitis media, isolated or traumatic tympanic membrane perforation), surgery performed (type 1 tympanoplasty, canal wall-up mastoidectomy, and exploratory tympanotomy), condition of the contralateral ear (unilateral/bilateral disease), graft material (temporal muscle fascia/tragal cartilage), preoperative and postoperative pure-tone audiometry thresholds and hearing gains, and postoperative sixth-month functional and anatomical graft success. Anatomical graft success and functional success were also evaluated according to the type of surgery performed, type of disease, type of fascia used in surgery, condition of the contralateral ear, and age. No statistically significant difference was found between the groups in terms of anatomical graft success and functional success according to the type of surgery performed (p = 0.414 and p = 0.123, respectively) and type of disease (p = 0.454 and p = 0.097, respectively). There was also no statistically significant difference between the anatomical and functional success of temporal muscle fascia and conchal cartilage grafts (p = 0.833 and p = 0.565, respectively). While no statistically significant difference was observed in graft success between the patients with and without contralateral ear disease, there was a statistically significant difference in functional success (p = 0.188 and p = 0.014, respectively). Although not statistically significant, it was observed that the anatomical graft success rates were decreased in patients with contralateral ear disease compared to those without bilateral disease (p = 0.188). There was no significant difference between age and anatomical graft success (p = 0.865) or functional success (p = 0.956). The type of disease in the diagnosed ear, presence of disease in the contralateral ear, and graft material used affect functional and anatomical graft success rates. Therefore, we believe that pediatric patients should be evaluated considering these factors in the preoperative period and the parents of these patients should be well informed about possible postoperative conditions [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]

Olfactory impairment in military populations is highly prevalent and often attributed to the long-term effects of mild traumatic brain injury (mTBI) and chronic psychiatric disorders. The main goal of this investigation was to examine olfactory function in a cohort of combat veterans using a quantitative smell test. Participants underwent a neurological examination, completed performance validity testing (PVT), provided deployment history, and their medical records were reviewed. Participants were 38 veterans with a deployment-related mTBI who passed the PVT and did not have ongoing substance misuse issues. Olfactory examination revealed normosmia in 20 participants and various degrees of deficit in 18. The groups did not differ in demographics, post-injury interval, or current clinical (non-psychiatric) conditions. Participants with hyposmia frequently reported being exposed to a higher number of blasts and being positioned closer to the nearest primary blast, and more often endorsed a period of loss of consciousness after the most serious mTBI. In addition, they more often reported tympanic membrane perforation, extracranial injuries, and histories of both blast and blunt force mTBI. Comorbid diagnoses of posttraumatic stress disorder, depression, chronic headaches, and pain were more common among them as well. Several blast exposure and injury-related characteristics increase the likelihood of long-term olfactory impartments, comorbid psychiatric conditions, and chronic pain among veterans with history of deployment-related mTBI. Notably, none of the participants with hyposmia had a clinical diagnosis of olfactory dysfunction or were receiving service-connected disability for loss of sense of smell at the time of their assessment. [ABSTRACT FROM AUTHOR]

Objective: Surgical repair of tympanic membrane perforations has been traditionally performed with autologous soft‐tissue grafts with high success rates. Newer allografts such as porcine small intestine submucosa (pSIS) have been employed as alternatives to minimize donor morbidity and surgical time, and in cases where autologous tissue may not be available. The comparative anatomic and audiometric success rates of these tissues is still unclear. Study design: Retrospective case–control series of anatomic and audiometric outcomes of autologous soft tissue versus pSIS graft for primary, isolated transmeatal tympanic membrane repair. Methods: Analysis of patients undergoing primary transmeatal tympanic membrane repair with autologous soft tissue or pSIS. Patients with otorrhea, cholesteatoma or retraction pockets, those who had cartilage grafts or ossicular reconstruction, and revision procedures were excluded. Pre‐ and post‐surgery air–bone gaps (ABG) and pure tone averages (PTA) were compared. Graft success was defined as closure of the perforation at 2‐month follow‐up visit. Results: The success rate for both the autologous soft tissue and the pSIS arm is 93.8%. There was no statistical significance (p <.05) between the post‐op ABG, change in ABG, post‐op PTA, change in PTA, or graft success rate between the two groups with either lumped cohort or matched‐pairs analysis. Conclusions: pSIS grafts are effective for repair of tympanic membrane perforations with hearing outcomes and graft success rates comparable to autologous soft tissue. Lay summary Repair of tympanic membrane perforations is traditionally done using a soft‐tissue graft harvested from the patient at the time of surgery. pSIS is a newer graft material that is equally effective in terms of anatomical and audiometric outcomes. Level of evidence: Level 3b. [ABSTRACT FROM AUTHOR]

Introduction: Tympanic membrane perforation (TMP) may be caused by several factors but commonly leads to conductive hearing loss. This study aims to characterize the profiles of hearing loss in pediatric patients with TMPs. Material and methods: A retrospective analysis of the medical charts of 27 patients was conducted. Otoscopy of the TM was done and pure tone audiometry was used to assess hearing loss. Cluster analysis was applied to evaluate the profiles of hearing loss and to find possible relations between profiles of hearing loss and the location of the perforation on the TM. Results: Cluster analysis revealed three types of hearing loss. The mean hearing loss in cluster 1 (6 cases) was above 30 dB, mainly as the result of perforation after chronic otitis media. Hearing loss in clusters 2 (9 cases) and 3 (12 cases) was less than 30 dB. In cluster 2 the perforation was mostly located in the posterior quadrants, while in cluster 3 it was most commonly in the inferior quadrants. In clusters 2 and 3, perforation was usually caused by slap of the open hand, injury, or past ventilation tube. Conclusions: Three different profiles (clusters) of hearing loss resulting from TMP were identified. Force of injury, etiology of the injury, and inflammation produce different sizes of perforations. Conductive hearing loss increases with perforation size and is independent of TM location. In general, hearing loss classification methods have the potential to improve diagnostic procedures, surgery, and rehabilitation of patients with TMPs. [ABSTRACT FROM AUTHOR]

Background: There is many civilians and soldiers who exposed to explosions in Iraq each month and they need an otolaryngological and audiological assessment. Objective: To recognize the possible auditory insults and the recovery period of the acquired damages that may resulted from explosion and help for planning of optimal management strategies of otological manifestations and prevent undesirable consequences. Patients and Methods: A prospective, descriptive study included forty-seven patients who were exposed to blast injuries within two weeks came to otolaryngology unit in Basrah Teaching Hospital complaining from otological symptoms from July 2017 tell January 2019. Three periodic assessments were done for each patient. An initial evaluation was done in the 1st visit included a detailed history and examination to evaluate the symptoms and assess the associated non-otological injury. An otological examination were done for all patients in the three visits, included microscopic ear examination, photos for the perforated tympanic membrane were taken to grade the perforations depending on their surface area, Pure tone audiometry and tympanometry. Thirty-eight patients were available to follow up in the 2nd and 3rd visits. Results: All of the 47 patients were young and middle age male, hearing loss and tinnitus were the most presenting symptoms, which improved with time. Hearing impairment mostly in the high frequencies however there was improvement in the subsequent visits. The majority of patients (93.6%) presented with tympanic membrane perforation mostly grade I which usually healed spontaneously. There was a statistically significant associations between the degree of tympanic membrane perforation and associated nonotological injuries and with the explosions if occurred in closed space. Conclusion: Blast related otological injury constitute the main cause of morbidity as the ear is the most sensitive organ to explosive blast injury. Hearing loss was the dominant symptoms at presentation mainly in high frequencies, but fortunately most of patients improved with time. Tympanic membrane perforation constituted the mostly seen sign, however spontaneous healing can be expected in the majority of cases. [ABSTRACT FROM AUTHOR]