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Objectives: To see the hearing outcomes following Type III tympanoplasty with stapes columella grafting after canal wall down mastoidectomy and find out the recurrence rates in patients undergoing this procedure. Methods: This prospective observational study includes 120 cases undergoing Type III tympanoplasty with stapes columella grafting following canal wall down mastoidectomy for cholesteatoma at a tertiary care center from 2018 to 2020. Patient charts were reviewed for demographic data, diagnosis, and operative details. Patients were included in statistical analysis if they were found to have undergone the aforementioned procedure. Evaluation of hearing improvement was made by comparing preoperative air-bone gap (ABG) and ABG at follow-up at 6 months and 1 year postoperatively. Results: One hundred and twenty patients were included for this study. Erosion of the otic capsule, posterior fossa plate, or tegmen was noted in 20% of cases, highlighting disease severity. One hundred and two (85%) had undergone prior otologic surgery. Mean time to short-term follow-up was 6 ± 3 months. The average short-term ABG was 25 ± 12 dB HL; 36% achieved an ABG

Introduction: Tympanoplasty is typically performed in conjunction with a canal wall down mastoidectomy in patient with Chronic Otitis Media Squamous. The results from experimental and clinical studies of the type III stapes columellar reconstruction have shown that interposing a disk of cartilage between the graft and the stapes head improves hearing in the lower frequencies by 5 to 10 dB. They hypothesize that the cartilage acts to increase the “effective” area of the graft that is coupled to the stapes, which leads to an increase in the middle ear gain of the reconstructed ear. Aims: To assess the hearing improvement after cartilage augmented Type III Tympanoplasty in chronic otitis media squamous disease. Methods: This study was conducted in 44 patients with Chronic Otitis Media squamous in the patients attending the department of Otorhinolaryngology in NGMC teaching hospital from November 2018 to March 2020. Canal Wall Down mastoidectomy with cartilage augmented type III Tympanoplasty and was done. Augmentation was done with thin 3-4 mm conchal cartilage interposed between stapes and Temporalis fascia graft. Results: There were 11(25%) male and 33(75%) female, with mean age of 29.48 years, ranging from minimum of 15 years to maximum 56 years. The preoperative mean A–B gap was 21.82 and postoperatively means AB gap was 12.20 dB with overall AB gap gain was 9.64 dB. Conclusion: Significant hearing improvement is seen in Canal Wall Down mastoidectomy Chronic Otitis Media squamous after cartilage augmented type III tympanoplasty.

Objective: To evaluate Hearing Status in Pre and Post-operative Canal Wall Down Mastoidectomy with Type III Tympanoplasty with or without cartilage augmentation. Methods: This was a prospective study, done in Otolaryngology & Head Neck Surgery department of Sir Salimullah Medical College Mitford Hospital(SSMCMH) and Bangabandhu Sheikh Mujib Medical University(BSMMU) , Dhaka, Bangladesh. 1stJuly to 31st December, 2012. Forty patients were studied in this series. Results: The results concluded that mean pre and post-operative air bone gap were 38.5 dB and 29.69 dB respectively with a net gain of 8.81 dB in Canal wall down mastoidectomy with cartilage augmented Tympanoplasty type III which is statistically significant. The postoperative PTA-ABG ranged from 25-36 dB , the ABG closure was 11-15 dB in 40% case. Whereas mean pre and post-operative air bone gap were 37.19 dB and 34.19 dB respectively with a net gain of 3 dB in Canal wall down mastoidectomy without cartilage augmented Tympanoplasty type III which is statistically insignificant. The post-operative PTA-ABG ranged from 26.25-41.75 dB, the ABG closure was 0-5 dB in 35% case. Conclusion: Hearing results after cartilage augmentation in type iii Tympanoplasty showed improvement at individual and mean post-operative PTA-ABG and also improvement in ABG closure suggesting thin cartilage disc increased the effective vibrating area of tympanic membrane graft. Bangladesh J Otorhinolaryngol; October 2020; 26(2): 86-94

Background: Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement in patients who underwent type III tympanoplasty using autologous incus and tragal cartilage as ossiculoplasty material. Method: A retrospective chart review of 30 patients who underwent type III tympanoplasty at medical college Srinagar Pauri Garhwal from January 2019 to December 2019 was done. In 10 patients autologous incus and in 20 tragal cartilage was used for ossiculoplasty. Those patients who required wall down were excluded from the study and only patient with limited atticotomy and complete mastoidectomy requiring type III tympanoplasty were included in the study. Pure tone audiograms done after 3 months were compared with the pre operative audiogram. Result: 10 patients who underwent type three tympanoplsty with use of autologous incus for ossiculoplasty had a mean hearing gain of 17.08dB and 20 pateint underwent type three tympanoplasty with use of tragal cartilage for ossiculoplasty had mean hearing gain of 18.26 dB at 3 months after surgery. Hearing gain was similar in both groups irrespective of the material used. The tragal cartilage was used as strut extending from stapes head to the anteroinferior part of annulus supporting the graft throughout and additionally helping in maintaining the middle ear space. Conclusion: The post-operative hearing gain with autologous incus and tragal cartilage as middle ear prosthesis are similar but the additional role of cartilage supporting the graft and maintaining the middle ear space overrule the use of tragal cartilage for ossiculoplasty in type three tympanoplasty. So by this study we recommend the use of tragal cartilage as ossiculoplasty material for type III tympanoplasty over other material.

Objective: To observe hearing status in case of canal wall down mastoidectomy with type III tympanoplasty. Methods: This was a cross sectional study which was carried out in the departments of Otolaryngology and Head-Neck surgery of Bangabondhu Sheikh Mujib Medical University during the period of July’ 2011 to March’ 2012.A Total 38 patients having cholesteatoma underwent canal down mastoidectomy with type III tympanoplasty,were included in this study. Patients were divided into two groups according to their age. Age belonged to 18 years and more than 18 years were considered as child and adult respectively. Patients were examined thoroughly and preoperative hearing level was assessed by pure tone audiometry one one week before operation. Post operative patients were followed up at regular intervals. Pure tone audiogram (PTA) was done after 8 weeks and hearing assessment was compared by closure of air bone gap. Results: In this study majority of patients were within 13-17 years in child group and 18- 35years in adult group. Most of patients were male.Closure of air-bone gap was significantly higher in adults. Improvement of hearing status was more in adults. Conclusion: CWD mastoidectomy with tympanoplasty not only lowers recurrence rate but also improves hearing status although less likely in child and younger age group than adults. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 52-58

To analyse the postoperative hearing results of patients undergoing type III tympanoplasty using sculptured homologous spur cartilage. This prospective study included 156 patients of chronic otitis media (COM), between the ages 10–60 years. All cases underwent type III tympanoplasty with ossiculoplasty using homologous spur cartilage. The study sample of 156 patients contained 107 cases of mucosal type and 49 cases of squamosal type COM. Type III A tympanoplasty was done for 71 cases and type III B tympanoplasty was done for 85. Pure tone audiometry (PTA) was done pre and postoperatively, in all the cases. The patients were followed up for 6 months postoperatively. The average preoperative mean air–bone–gap (ABG) was 43.64 dB, whereas in type III A cases it was 39.7 dB and in type III B it was 46.9 dB. The mean ABG at 6th month follow up was 18.9 dB in the study group. In type III A cases, mean ABG was 15.2 dB and in type III B cases it was 22.11 dB. Homogenous spur cartilage graft can be used for ossicular chain reconstruction with the advantage of very low extrusion rate, technically easy to perform with less risk of residual disease.

This prospective observational study evaluates the role of tympanoplasty type III in cholesteatoma ear disease during same sitting with mastoid surgery using cartilage ossiculoplasty. Forty patients of chronic suppurative otitis media-cholesteatoma disease were recruited in the study. All the patients had extensive cholesteatoma and underwent canal wall down mastoid surgery. Tympanoplasty type III, that is, stapes columella, minor columella, or major columella, was done in each case along with mastoid surgery depending upon the remnant ossicular status. Conchal cartilage graft was used for ossiculoplasty along with temporalis fascia graft. Hearing and graft uptake results were evaluated at the end of 6 months postoperatively. Of the 40 cases, 3 cases failed tympanoplasty. In the remaining 37 cases, a statistically significant hearing improvement (air–bone gap of 33 dB) was observed postoperatively. Seven cases underwent stapes columella, 13 cases underwent minor columella, and 17 cases underwent major columella tympanoplasty type III. Although a hearing improvement was recorded in all these subgroups, a statistically significant hearing gain was present only in tympanoplasty type III minor columella cases thereby underlying the importance of intact stapes. However, it is difficult to discern the type of tympanoplasty type III that the patient would undergo prior to the ear surgery

The objective of this study is to compare hearing improvements in the air-bone gap (ABG) after type III tympanoplasties, comparing between incus transposition (IT) and partial ossicular replacement prosthesis (PORP).Publications in English were searched in PUBMED database and were systematically reviewed. A total of 14 articles were included, obtaining 1055 patients, 614 for the IT group and 441 for the PORP group. Preoperative ABG, postoperative ABG, dB gain and ABG closure rate were compared.IT group: preoperative ABG of 31.74 dB (SD 10.51); postoperative ABG of 18.97 dB (SD 10.6); dB gain of 12.76 dB (SD 14.97); and ABG closure rate of 64.48%. PORP group: preoperative ABG of 28.02 dB (SD 10.47); postoperative ABG of 16.27 dB (SD 10.45); dB gain of 11.75 (SD 15.02); and ABG closure rate of 71.32%. No significant statistical difference was found in dB mean gain between groups (p .05), although a difference was found in the ABG closure rate between groups favouring PORP series (p .05).An improvement in hearing results was observed within both groups after type III tympanoplasty. There is no difference in decibels gained between both ossiculoplasty materials, but a better closure rate (%) was observed in the PORP group.

Introduction In conventional Type III tympanoplasty, post operative air-bone gap (ABG) is around 10-60dB. This study aimed to assess the hearing results in patients undergoing canal wall down mastoidectomy with cartilage augmented type III tympanoplasty. Materials and Methods Patients of 6-50 years of age with the diagnosis of Chronic Otitis Media (Squamous) with conductive or mixed hearing loss, requiring canal wall down mastoidectomy and with intact and mobile stapes suprastructure at surgery who underwent cartilage augmentation were included in the study. Pure tone audiometry (PTA) was performed and evaluated. Post- operative hearing was assessed in terms of average air bone gap (ABG) and size of ABG closure. Results The results concluded that mean of pre and post operative air bone gap were 37.5db and 29.7db respectively with net gain of 7.8db.These differences were significant. Also ABG closure was within 30 db in 28 cases (70%). Discussion The results of this study were compared with other reported series. The mechanical and acoustical aspects of canal wall down surgeries as also the probability of variation in results due to differences in surgical procedures and post-operative fibrosis have been mentioned. Conclusion There was significant improvement in postoperative hearing after stapes head augmentation in type III tympanoplasty.

Background: Type III tympanoplasty involves complete disease clearance from middle ear cleft and retaining or improving the serviceable hearing by ossiculoplasty. Various auto and allografts have been used with variable outcomes. The objective of the study was to evaluate hearing improvement and healing of cavity in patients who underwent type III tympanoplasty.Methods: A retrospective chart review of 21 patients who underwent type III tympanoplasty at Bowring and Lady Curzon Hospital from January 2018 to December 2018 was done. In 7 patients autologous incus, 6 tragal cartilage and 8 teflon prosthesis was used for ossiculoplasty. Intra and postoperative events were assessed. Pure tone audiograms done after 3 and 6 months were compared. Results: 15 patients who underwent canal wall down procedure (CWDP) had a mean hearing gain of 20.33 dB and 26.67 dB while in 5 patients of canal wall up procedure (CWUP) group mean hearing gain was 22.5 dB and 27.5 dB at 3 and 6 months after surgery respectively. Hearing gain was similar in both groups irrespective of the prosthesis used. Autologous materials were used in most of the CWUP with intact stapes and teflon prosthesis was used in majority of CWDP where only mobile stapes foot plate was present. Prosthesis extrusion was not encountered in any of our cases so far in this series.Conclusions: The post-operative hearing gain with autologous incus, tragal cartilage and teflon middle ear prosthesis are similar. Teflon prosthesis is an effective material for ossiculoplasty, especially useful when incus and stapes are absent while autologous incus or tragal cartilage are preferred in cases with intact stapes head.

Seven hundred and eighty-four patients who underwent ossiculoplasty performed by a single surgeon were reviewed in this paper. We previously reported a similar study in another journal using the 1995 American Academy of Otolaryngology Head and Neck Surgery guidelines. In the present paper, hearing outcomes were estimated based on the 2000 Japan Otological Society guidelines. The prognostic factors were analyzed using a multivariate analysis with logistic regression. Hearing outcomes were successful in 517 patients (65.9%). Type III tympanoplasty, stapes with normal mobility, children, patients without cholesteatoma and ossiculoplasty with non-cartilaginous materials were significantly favorable predictive factors. A multivariate analysis should be performed to investigate prognostic factors of ossiculoplasty. Better knowledge of these predictive factors contributes to the surgeon's judgment and the information given to patients.

Chronic suppurative otitis media with cholesteatoma is a fairly common condition presenting in any ENT clinic and its surgery remains one of the most challenging surgeries in otology. The primary goal of cholesteatoma surgery is to clear the disease and produce a safe and stable ear but there is still debate on whether these goals are best achieved by canal wall down or canal wall up procedures. A retrospective study was done to access benefits of modified radical mastoidectomy (MRM) with type III tympanoplasty in terms of eradication of disease and hearing improvement. It consisted of 140 patients of chronic otitis media (attico-antral) who underwent MRM with type III tympanoplasty in 156 ears in a tertiary care centre. Temporalis fascia graft was used for tympanoplasty. Results were analyzed in terms of condition of cavity, condition of graft and gain in hearing. The study showed significant improvement in gain in air conduction (21.24 dB) and closure of AB gap (15.62 dB). In the Indian population with low socio-economic status and poor follow up, single stage canal wall down procedure (MRM) provides maximum benefit to patients in terms of eradication of disease and hearing improvement.

To determine the morphologic and hearing results of the combined application of the palisade cartilage technique and titanium ossicular replacement prostheses in Type III tympanoplasty.Retrospective review of 61 tympanoplasties.Tertiary referral center.59 patients (39 women and 20 men, mean age 36 years, range 7-81 years) consecutively operated on because of cholesteatoma, adhesive otitis, chronic otitis media, subtotal tympanic membrane defects, and tympanofibrosis requiring tympanoplasty with ossiculoplasty.Tympanoplasty Type III, with application of the palisade cartilage technique and total or partial titanium ossicular replacement prosthesis.Otoscopic findings and hearing results using a four-frequency pure tone average air-bone gap.A recurrent defect was seen in 1 ear (1.6%). The graft take rate was 100%. There were no extrusions of prostheses. Preoperatively, a pure tone average air-bone gap of 0 to 10 dB was seen in 1 ear, 11 to 30 dB in 30, and 31 to 50 dB in another 30 ears. Postoperatively, the corresponding numbers were 11, 41, and 9 ears, respectively. Hearing results were better in the total ossicular replacement prosthesis group.The palisade cartilage technique is suitable to manage difficult pathologic conditions in middle ear surgery. It was demonstrated that the palisade cartilage technique can be combined safely with titanium ossicular replacement prostheses. Regarding postoperative hearing results, the negative preselection of pathologic conditions must be considered.

In the past 4 years, middle ear surgery has been performed on 166 ears. A total of 42 ears operated on by modified type III tympanoplasties, and 19 ears operated on by type IV tympanoplasties were reviewed. The type III tympanoplasty group included 12 ears with cholesteatoma and 20 with chronic otitis media. The type IV tympanoplasty group included 9 cases of cholesteatoma and 5 cases of chronic otitis media. Postoperative hearing results were evaluated, and success rates in hearing results were 81.6% of type III patients, and 66.7% of type IV tympanoplasty patients. Second surgeries were performed on 7 ears previously operated on at other hospitals, and success was observed in 6 ears. In 18 ears, artificial columella (hydroxyapatite) was used for reconstruction of the ossicular chain, and discharge of the columella was observed in only 1 ear. In 21 ears with cholesteatoma and reconstruction of the ossicular chain, residual recurrence of cholesteatoma was observed in 3, but true recurrence of cholesteatoma was not experienced.

There are two main problems for artificial ossicular chain prosthesis ; extrusion and postoperative slippage of prosthesis. We manufactured a new hydroxylapatite prosthesis “carti-lage connecting ossicular chain prosthesis” with a planar-like head portion to contact with a piece of cartilage. As a result, postoperative extrusion rate was 4/124 (3.2 %) which seemed lower than the conventional type, and hearing success rates were 78.8 % in modified type III tympanoplasty, 80.0 % in modified type IV tympanoplasty. Average improvement on air conduction were 13.5 dB in modified type III tympanoplasty, 17.5 dB in modified type IV tympanoplasty. Those good results were explained by that the “Cartilage connecting ossicular chain prosthesis” Was tightly attached with a reconstructed tympanic membrane and ossicular chain prosthesis might be stable in tympanic cavity.

Since the first description of middle ear osteomas by Thomas in 1964, only few reports were published within the English literatures (Greinwalid et al., 1998; Shimizu et al., 2003; Cho et al., 2005; and Jang et al., 2009), and only one case of the multiple osteomas in middle ear was described by Kim et al., 2006, which arose from the promontory, lateral semicircular canal, and epitympanum. Here we describe a patient with multiple middle ear osteomas arising from the promontory, incus, Eustachian tube, and bony semicanal of tensor tympani muscle. This patient also contracted the chronic otitis media in the ipsilateral ear. The osteomas were successfully removed by performing type III tympanoplasty in one stage.

To evaluate anatomical and functional results using titanium prostheses in cartilage palisade tympanoplasties.Retrospective clinical study. Data were collected from patients' charts and clinical review.Tertiary referral center.Cartilage tympanoplasty with titanium total ossicular replacement prosthesis after tympanoplasty or tympanomastoidectomy in patients operated on between July 1998 and February 2006.Anatomical results (closure of the perforation, rate of retraction pockets, recurrent cholesteatoma, and extrusion and re-perforation rates) were clinically evaluated. Pure-tone averages of air and bone conduction were analyzed. A postoperative air-bone gap (ABG) of 20 dB or less was taken to represent successful hearing.The hearing outcomes of canal wall up (CWU), canal wall down (CWD), primary and revision surgeries, and 2 groups of a short-term (12 mo) or long-term (24 mo) follow-up (f-u) were assessed and compared.Ninety-four cases were observed during the visiting period: 43 (45.7%) underwent primary procedures and 51 (54.3%) underwent revision surgeries. Closure of the tympanic membrane was achieved in 98.9%.Postoperative ABG was 20 dB or lower in 62 (66%) of 93 cases, between 11 and 20 dB in 33 cases (35%), and 10 dB or lower in 29 cases (31%).All cases undergoing CWU had a mean +/- SD postoperative ABG of 14.59 +/- 11.28 dB. There were no statistically significant differences (independent-samples t test, p = 0.5) between these patients and those receiving CWD surgery (15.95 +/- 10 dB).Thirty-eight (68%) of 56 CWD and 24 (64%) of 37 CWU cases achieved a postoperative ABG between 0 and 20 dB (chi = 0.08, p = 0.7, correlation = 0.031).Thirty-three (64.7%) of 51 who underwent revision surgeries and 29 (69%) of 42 who underwent primary procedures had a postoperative ABG between 0 and 20 dB. The difference between the groups was not significant (chi = 0.3, correlation = 0.058, p = 0.5).The mean ABG in the short f-u group was 12.38 +/- 7.34. There was no significant difference regarding long-term f-u after 24 months (11.76 +/- 8.9; Wilcoxon signed-rank test, p = 0.7).We compared the mean postoperative ABG in low hearing frequencies (500 and 1,000 Hz) and high hearing frequencies (2,000 and 4,000 Hz). A better sound transmission was achieved in high frequencies (10.32 +/- 10.6 versus 20.61 +/- 13.73 dB, respectively); the difference was statistically significant (p0.001, paired-samples t test).Our results suggest that tympanoplasty with titanium total ossicular replacement prosthesis reconstruction offers a stable improvement of the ABG less than 20 dB in 66% of cases, in both short-term and long-term f-u. There were no differences in the results between CWU and CWD or between primary and revision surgery. The titanium prosthesis achieves the best acoustical results for sound transmission at high frequencies (2,000 and 4,000 Hz).

This study was done to compare the pre and post-operative hearing results in patients undergoingcanal wall down mastoidectomy with classical type III tympanoplasty using temporalis fasciaalone.Patients of ≥5 years age with the diagnosis of Chronic otitis media (squamous) with conductive ormixed hearing loss, needing canal wall down mastoidectomy and with intact and mobile stapessuprastructure at surgery who underwent classical type III tympanoplasty were included in thestudy. The pre and post-operative PTA was performed and evaluated. The post-operative hearingwas assessed in terms of average ABG and size of ABG closure.Mean pre and post-operative air bone gap in classical type III tympanoplasty were 37.8 dB and 29.8dB respectively and these differences were statistically significant. The postoperative PTA-ABGranged from 15-61.2 dB.Hearing results after type III tympanoplasty varied widely showing statistically significantimprovement in mean post-operative PTA-ABG but there was a great variation.Key words: air bone gap, chronic otitis media, mastoidectomy, tympanoplasty

Myringostapediopexy may be used as part of tympanoplasty following mastoid operations. We describe a technique of placing releasing incisions on the tympanic membrane to ensure good contact between it and the stapes head.

Seven patients with post-traumatic ossicular disruption are described. Average hearing impairment for the 7 patients was 45.9dB. An exploratory tympanotomy was carried out in all patients.During surgery, discontinuity was found in the incudostapedial (IS) joint in 4 patients, in the malleoincudal (MI) joint in 1 patient, and in both the IS and MI joint in 2 patients.The discontinuity was reconstructed by type III tympanoplasty in 6 patients. Four of the total 7 patients were transposed and the incus body was trimmed. The other 2 patients were PORP. Hearing impairment averaged 13.1dB after tympanoplasty.Cases of conductive deafness are occasionally encountered, in which it is difficult to confirm the presence of pathological lesions by conventional hearing and imaging tests, necessitating exploratory surgery. It is possible to improve hearing impairment significantly in many of these cases by performing a tympanoplasty. Therefore, in patients with similar lesions after head trauma, aggressive treatment is recommended with prerequisite informed consent.

To evaluate the long-term anatomic and functional results after partial and total autologous cartilage palisade type III tympanoplasties to assess the efficacy of cartilage palisades in preventing recurrent cholesteatoma.Retrospective data bank and patient review.Tertiary referral center.The study population included all patients with more than 36 months follow-up who underwent tympanoplasty or tympanomastoidectomy for previously untreated cholesteatoma using partial or total autologous cartilage palisade graft associated with a reconstruction of the ossicular chain from October 1, 1992, to October 31, 1998.Tympanoplasty or tympanomastoidectomy using autologous cartilage palisade graft for partial or total reconstruction of the tympanic membrane and the ossicular chain.Anatomic results, i.e., closure of the perforation, rate of retraction pockets, recurrent cholesteatoma, and reperforation rate related to the use of autologous cartilage were clinically evaluated. Postoperative speech reception thresholds, speech discrimination scores, and postoperative air-bone gap were compared with preoperative levels. The outcomes of canal wall up and canal wall down procedures were compared.Closure of the tympanic membrane was achieved in 98.3% of patients. Speech reception thresholds did not change significantly. Speech discrimination scores were stable or improved in all patients. Postoperative air-bone gap was less than 10 dB in 29.8% of patients and between 11 and 20 dB in 32.3%. The complication rate of the tympanoplasty in general was 0.67%. The rate of recurrences of cholesteatoma was 2.2%. No complications could be related to the use of cartilage.The cartilage palisade technique is effective for the reconstruction of the tympanic membrane and also prevents new retractions and recurrences of cholesteatoma. The functional results show that autologous cartilage grafts are able to transmit sound.

Canal wall-down technique tympanoplasty was indicated in about 41 per cent of our cases with chronic suppurative otitis media. In this series done during the last four years, of 576 tympanoplasties, 240 cases needed type III tympanoplasty. In 145 cases, myringostapediopexy was carried out using temporalis fascia grafting over the head of the stapes. Tympano-cartilago-stapediopexy was performed in the other 95 cases by using tragal cartilage and perichondrium over the stapes. A comparison between the results of both methods of grafting is discussed. Improvement in hearing was achieved after tympano-cartilago-stapediopexy. This method proved to be suitable for those cases which need open technique tympanoplasty.

Aims: The aim of the present study was to find out the hearing improvement in different types of tympanoplasties. Settings and Design: Prospective, hospital-based. Subjects and Methods : A total of 50 patients were included who were 12 years old and above, of both sexes with conductive hearing loss due chronic otitis media with or without perforation. Results: The ratio of males (28) was more as compared with females (22). Maximum number of patients belonged to the age group of 10-20 years (34%), followed by 20-30 years (30%), whereas least number of cases was found in the age group of > 50 years. Hearing loss and otorrhea were present in majority of the cases (100% and 72%, respectively). A total of 18 of the cases had cholesteatomatous chronic suppurative otitis media, while 32 ears were observed to be noncholesteatomatous chronic suppurative otitis media. The average preoperative air conduction (AC) in the present study was found to be 46.6 dB ranging from 20 dB to 112.5 dB, while the average postoperative AC was found to be 39 dB with an average gain of 7.6 dB. The four frequency average preoperative and postoperative air-bone gap (ABG) were found to be 26.48 dB and 20.17 dB respectively, with the average gain of 6.3 dB. The average ABG closure within 0-30 dB was seen in 33 (82%) of the cases. Social hearing was achieved in 86% of the cases in type I, 46% in type II, and 40% in type III tympanoplasty. Conclusions: Tympanoplasty as a procedure when indicated without compromising for the disease, can be effectively used to improve hearing in chronic suppurative otitis media, and other types of conductive hearing losses.

The relationship between the contralateral hearing threshold in the operated ear and the type of tympanoplasty and the hearing threshold in the operated ear was investigated in this report. The subjects of analysis were 863 ears that received tympanoplasty during the past nine years at the Nippon Medical School Main Hospital. Patients who had good hearing in the contralateral ear received type I tympanoplasty more frequently than did those who had poor hearing on the contralateral ear. On the other hand, patients who had poor hearing in the contralateral ear received a modified type III tympanoplasty more frequently. Patients who had good hearing in the contralateral ear tended to have better hearing in the operated ear compared to those who had poor hearing in the contralateral ear. The hearing threshold in patients who had normal contralateral hearing on the average had 20 dB better hearing than did those who had profound hearing loss in the contralateral ear. More than one third of the patients whose hearing thresholds were worse than 30 dB in the operated ear also had a contralateral hearing loss of 30 dB or more. The decision to perform tympanoplasty in cases of the better hearing ear or the only hearing ear must be made very carefully. The contralateral hearing in patients with chronic otitis media, however, is frequently not normal as was evidenced in this investigation. Also, patients who had poor hearing or were deaf in the contralateral ear received more benefit by tympanoplasty than did those who had good hearing in the contralateral ear.(ABSTRACT TRUNCATED AT 250 WORDS)

A study on the use of tragal perichondrium as a graft in tympanoplasty was made. Autogenous tragal perichondrium was used in 50 cases of C.S.O.M., undergoing tympanoplasty. Type I was performed in 38 cases, Type II in 5 cases and in 7 cases Type III tympanoplasty was done. The important advantages noticed during the surgery were the ease with which the fairly big sized graft was made available from the field of operation and the comfort with which the perichondrium could be handled without getting curled up. Post-operatively, the graft rejection was seen in only 4 cases (8.5%) while in rest 46 cases (91.5%) the graft take up was excellent. Sufficient gain in hearing was also obtained in 39 (8.3%) cases. It is expected that this graft (perichondriuum from tragus) will go a long way in solving the main problem of graft rraterial in tympanoplasty.

Keywords: Air bone gap; chronic media (squamous); canal wall down mastoidectomy; cartilage augmentation type III tympanoplastyDOI: 10.3126/njenthns.v1i2.4752 Nepalese J ENT Head Neck Surg Vol.1 No.2 (2010) p.3-5

The three surgical methods currently in use to improve hearing for patients with congenital aural atresia are fenestration of the lateral semicircular canal, canal plasty, and type III tympanoplasty. Because the surgery is difficult and the functional rewards are modest, it should ordinarily be reserved for patients with bilateral atresia. Of the 12 ears operated by the technique of type III tympanoplasty, the average gain in hearing was 22 dB, with seven attaining a 30 dB or better air-conduction threshold. When aural rehabilitative and cosmetic surgery are contemplated, coordinated planning by the surgeons is necessary to acquire the best end result.