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Cartilage tympanoplasty is a fast growing technique used to restore hearing in chronic suppurative otitis media. The technique has misnomers such as limited applicability in only small size perforations, interference with sound conducting mechanism and durability. Our experience in out tertiary care Institution with over 100 retrospective study cases prove that there is a scope of proving it to be well established technique. That could be used in par with other tympanoplasty techniques. Our retrospective case series of 100 operated between 2021 and 2024 were taken, having unilateral perforation convenience data collection purpose. The overall success rates of cartilage / button tympanoplasty of varying perforation sizes, having a wide range of pure tone audiometry statuses having successful results were discussed, which is indicated as a percentage format. In our retrospective case series, out of our 100 cases we had 90 successful graft uptake cases. The 10% cases were later followed up in our study. It was analysed and concluded that the technique was not the inhibiting factor but the post operative care had prevented the patients from having the desired results. Our results are in accordance with previous case studies for support. Pure tone audiometry were taken pre operatively and post operatively that support cartilage / button tympanoplasty. Cartilage tympanoplasty is a commonly misunderstood technique which if corrected has a wide scope to be used a s a common treatment modality. Data collected and inference were in concordance with previous studies conducted. Tragal cartilage due to its durability, low inflammatory reaction to tympanic membrane, lesser chances of retraction and long term assurance of withstanding environmental conditions has proven to be technique which can be used in regular basis. Cartilage / button tympanoplasty is a technique that has a shorter learning curve for surgeons. With a high demand of cases in chronic suppurative otitis media-Tubotympanic type, button tympanoplasty technique is an assest. [ABSTRACT FROM AUTHOR]

Middle ear aeration is a predictive indicator of myringoplasty's successful outcome and tympanometric ear canal volume is a novel investigation that can estimate the volume of middle ear cleft and mastoid air cells. Our aim of this study is to determine the role of tympanometric ear canal volume on myringoplasty outcome in Chronic Suppurative Otitis Media Patients. Prospective analysis involving 50 patients of CSOM was performed on patients undergoing myringoplasty from April 2022 to December 2023. Smokers, Patients with squamosal COM, Bilateral COM, Otitis Externa, and Revision surgery were excluded from the study. The successful outcome of surgery was defined as no tympanic membrane perforation on postoperative follow-up. Analysis was carried out using SPSS. V. 25 and P-value less than 0.05 was considered significant. A total of 50 patients were included in the study with a mean age of 24.4 ± 8.965 and male predominance. Overall graft uptake was 64%. Graft uptake had no significant statistical correlation with age, gender, type, location, or size of perforation. However, there is a significant effect of tympanometric ear canal volume of pathological ear and interaural tympanometric ear canal volume difference on graft uptake with p-values of 0.023 and 0.033 respectively. Tympanometric ear canal volume can predict middle ear aeration and the higher the interaural tympanometric canal difference more are the chances of successful graft uptake. [ABSTRACT FROM AUTHOR]

Since 1952, myringoplasty has evolved with various surgical techniques, including overlay, underlay, sandwich, pegging, rosette, and plugging. Overlay and underlay methods are most commonly used. In 1998, Eavey introduced the cartilage and perichondrium butterfly inlay myringoplasty, designed for small to medium-sized perforation closure, offering practical advantages such as reduced surgical time and improved hearing outcomes. A one-year prospective study (September 2022 to September 2023) in a tertiary care hospital in India involved 30 patients aged 9–52 years with inactive small central perforations. Pre-operative pure tone audiometry (PTA) results were required to be no higher than 35 dB conductive hearing loss. General or local anesthesia was used based on the patient's age. The surgical technique involved visualizing the perforation, graft preparation, and transcanal insertion. Among the 30 patients, the graft uptake rate was 100% at 3 months and 93.33% at 6 months. Pre-operative mean PTA was 29.76 dB, which decreased to 25.03 dB post-operatively, with a statistically significant air-bone gap closure of 4.73 dB. Cartilage rosette inlay-onlay myringoplasty offers an effective solution for small to medium-sized perforations, achieving high success rates (93.33%). This technique is associated with reduced surgical time, suitability for day care surgery, and minimal scarring, making it a valuable addition to routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: We compared and analyzed the surgical results of fat myringoplasty between elderly and young adult patients with chronic otitis media. We also investigated whether underlying diseases and other factors impact the surgical outcome. Methods: We retrospectively reviewed the data of 141 patients who underwent fat myringoplasty for chronic otitis media for five years. They were compared by age, sex, underlying disease, perforation size, pre- and postoperative pure tone audiometry, postoperative otorrhea, postoperative re-perforation, and cause of re-perforation. Result: Postoperative re-perforation was more common in the elderly group, albeit with no significant difference (p = 0.072). The factors affecting re-perforation were insufficient fat graft (44.4%), postoperative infection (33.3%), and nasal blowing (22.2%). Our findings revealed no significant association between preoperative perforation size and re-perforation (p = 0.391). Additionally, we found no significant relationship between hypertension and re-perforation (p > 0.99), nor between age group and postoperative infection (p = 0.488). Diabetes was also not significant (p = 0.640). Following surgery, both groups exhibited a significant improvement in hearing. Conclusion: Although age and underlying conditions play significant roles in the healing process, our results suggest that external factors such as infection, nasal blowing, cough, and insufficient grafted fat tissue have a similarly significant impact on surgical outcomes in elderly patients with COM as they do in adults. In conclusion, the decision to perform surgery in elderly patients with COM should be based on a comprehensive assessment of the patient's overall health status, hearing, use of hearing aids, and the indications for surgery. [ABSTRACT FROM AUTHOR]

Purpose: Retrospective evaluation of bilateral same-day myringoplasty outcomes. Methods: Patients who underwent bilateral same-day myringoplasty from 2005 to 2019. Results: Thirty-eight patients underwent bilateral myringoplasty. Mean age was 44.5 years and 55.3% patients were male. Tragal perichondrium-cartilage composite graft was the most frequently used graft material (82.9%). Perforation closure was achieved in 78.9%. Postoperative Pure Tone Average and Air–Bone Gap decreased significantly (p < 0.05), except for the Air–Bone Gap of the right ear (p = 0.058). The complications were cholesteatoma (1.3%), otorrhea (6.6%) and tympanic membrane retraction (1.3%). Conclusions: Bilateral same-day myringoplasty is a feasible procedure in selected patients. Good anatomic and functional outcomes, as well as a low rate of complications, are achieved with this procedure, improving patient comfort and allowing for a reduction in operation time and costs. [ABSTRACT FROM AUTHOR]

Background: Myringoplasty is one of the most common surgeries performed in otology centers, with many factors influencing the success rate, including the size and site of perforation, function of the Eustachian tube, revision surgery, and expertise of the surgeons. It is well established that the perforation closure rate is lower when performed by trainee surgeons than by senior otologists. Myringoplasty performed by trainees tends to pose more iatrogenic trauma to middle ear mucosa, less gentle manipulation of ossicles, and prolonged operation time compared with operations performed by experienced surgeons, all of which might produce more damage to middle ear structures and consequently negatively affect the closure rate of TM and audiological outcome. This study aimed to assess the audiological outcomes of successfully closed perforation myringoplasty performed by a trainee under supervision. Methods: The study design was an analytic cross-sectional study of 35 patients aged between 6 and 62 years diagnosed with safe TM perforation. All patients had two audiograms, one before surgery and the other 3 months after surgery. The exclusion criteria included any case with cholesteatoma, tumor, tympanosclerosis, or ossicular erosion/fixation because this study aimed to study the sole effect of closing TM perforation without any other confounding factor. Results: The results indicate a mean hearing improvement of 12.25 dB of ABG and 10.6 dB of AC thresholds at the four frequencies of 500, 1000, 2000, and 4000 Hz. The mean of the residual ABGs at the four frequencies is 14.2 dB. There were no correlations between the amount of air conduction threshold improvement and age, gender, side of the affected ear, area of perforation, or duration of disease (p > 0.05 for all tests). Conclusion: Although the rate of perforation closure in myringoplasties performed by trainees is lower than that of experienced surgeons, the audiological outcomes of myringoplasties performed by trainees under supervision were acceptable; however, further research is recommended. [ABSTRACT FROM AUTHOR]

Autologous Platelet-rich fibrin (PRF) is an amalgam of fibrin mesh, platelets and growth factors that favour wound healing. It can be easily used as a graft material in myringoplasty, making it a promising, easy to harvest and cost effective alternative compared to cartilage or fascia graft used in conventional myringoplasty. 50 patients of small to medium, dry central perforation underwent myringoplasty using PRF graft (Group 1). Results were compared to 50 patients with similar small to medium perforations who underwent conventional transcanal myringoplasty using temporalis fascia graft (Group 2): Outcome of surgery was measured by closure of perforation and improvement in hearing at 3 months. In group 1, overall closure rate was 70% while in group 2 it was 96%. For both small and medium perforations healing was significantly higher in group 2 compared to group 1, (100% vs 87.5%) for small perforations and (95.45% vs 66.67%) for medium perforations. Hearing gain was comparable in both groups in patients in whom healing of perforation occurred. PRF stands as a suitable graft material for closure of small perforations, but, lack of rigidity and early disintegration of the graft makes it less suitable for larger perforations compared to other conventional grafts such as temporalis fascia. [ABSTRACT FROM AUTHOR]

The spectrum of surgical techniques in the repair of nasal septal defects is wide. The objective of this study was to assess the feasibility of using a diced cartilage in fascia (DC-F) graft for successful closure of nasal septal perforations and to evaluate symptom reduction. This was a retrospective study of 18 patients undergoing surgical repair of symptomatic nasoseptal perforations of different etiologies using a DC-F graft from 2020 until 2021. The procedure was feasible in all of the 18 patients. Reconstruction of septal defects with a DC-F graft led to reduction of crust formation, reduction of epistaxis, and improvement of nasal breathing in 13 out of the 18 patients when seen for their 2-month follow-up. Reperforation occurred in three cases, leaving defects of 1, 7, and 5 mm in diameter. In one case, the reperforation was symptomatic. A DC-F graft proved to be a reliable and reproducible method for the closure of nasoseptal perforations of variable sizes, of different locations, and of different etiologies. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the current study is to compare the surgical and audiometric results of conventional incus interposition (IP) versus malleostapediopexy (MS) in incus long process large defects. Methods: A total of 71 patients (incus IP group n = 37, MS group n = 34) were enrolled in this study. All patients enrolled in the current study underwent ossiculoplasty via an exclusive endoscopic transcanal approach. Pre- and postoperative audiometric measurements and air–bone gap (ABG) values were compared, and if the postoperative ABG value was less than 20 dB, ossiculoplasty was considered successful. Graft success rates and complications were also compared. Results: The average auditory gain was 14.7 ± 4.2 dB in the incus IP group and 18.3 ± 5.1 dB in the MS group. The auditory gain was significantly greater in the MS group relative to the incus IP group (p = 0.012). Ossiculoplasty success (postoperative ABG value < 20 dB) rate was 70.3% in the incus IP group patients and 88.2% in the MS group patients (p < 0.001). There was no significant difference in terms of graft success rate between groups (p > 0.05) and the overall graft uptake rate was 91.5% (65/71). Conclusion: Malleostapediopexy—bridging of malleus and stapes using bone cement—is an effective, reasonable, and more efficient technique in terms of auditory outcomes relative to the conventional incus interposition in endoscopic transcanal management of incus long process major defects. [ABSTRACT FROM AUTHOR]

Abstract Background Myringoplasty is one of the most common surgeries performed in otology centers, with many factors influencing the success rate, including the size and site of perforation, function of the Eustachian tube, revision surgery, and expertise of the surgeons. It is well established that the perforation closure rate is lower when performed by trainee surgeons than by senior otologists. Myringoplasty performed by trainees tends to pose more iatrogenic trauma to middle ear mucosa, less gentle manipulation of ossicles, and prolonged operation time compared with operations performed by experienced surgeons, all of which might produce more damage to middle ear structures and consequently negatively affect the closure rate of TM and audiological outcome. This study aimed to assess the audiological outcomes of successfully closed perforation myringoplasty performed by a trainee under supervision. Methods The study design was an analytic cross-sectional study of 35 patients aged between 6 and 62 years diagnosed with safe TM perforation. All patients had two audiograms, one before surgery and the other 3 months after surgery. The exclusion criteria included any case with cholesteatoma, tumor, tympanosclerosis, or ossicular erosion/fixation because this study aimed to study the sole effect of closing TM perforation without any other confounding factor. Results The results indicate a mean hearing improvement of 12.25 dB of ABG and 10.6 dB of AC thresholds at the four frequencies of 500, 1000, 2000, and 4000 Hz. The mean of the residual ABGs at the four frequencies is 14.2 dB. There were no correlations between the amount of air conduction threshold improvement and age, gender, side of the affected ear, area of perforation, or duration of disease (p > 0.05 for all tests). Conclusion Although the rate of perforation closure in myringoplasties performed by trainees is lower than that of experienced surgeons, the audiological outcomes of myringoplasties performed by trainees under supervision were acceptable; however, further research is recommended.

Approximately 740 million symptomatic patients are affected by otitis media every year. Being an inflammatory disease affecting the middle ear, it is one of the primary causes of tympanic membrane (TM) perforations, often resulting in impaired hearing abilities. Antibiotic therapy using broad-spectrum fluoroquinolones, such as ciprofloxacin (CIP), is frequently employed and considered the optimal route to treat otitis media. However, patients often get exposed to high dosages to compensate for the low drug concentration reaching the affected site. Therefore, this study aims to integrate tissue engineering with drug delivery strategies to create biomimetic scaffolds promoting TM regeneration while facilitating a localized release of CIP. Distinct electrospinning (ES) modalities were designed in this regard either by blending CIP into the polymer ES solution or by incorporating nanoparticles-based co-ES/electrospraying. The combination of these modalities was investigated as well. A broad range of release kinetic profiles was achieved from the fabricated scaffolds, thereby offering a wide spectrum of antibiotic concentrations that could serve patients with diverse therapeutic needs. Furthermore, the incorporation of CIP into the TM patches demonstrated a favorable influence on their resultant mechanical properties. Biological studies performed with human mesenchymal stromal cells confirmed the absence of any cytotoxic or anti-proliferative effects from the released antibiotic. Finally, antibacterial assays validated the efficacy of CIP-loaded scaffolds in suppressing bacterial infections, highlighting their promising relevance for TM applications.

This document provides information on the treatment of pharyngeal pouches, which are herniations of the pharyngeal mucosa that can cause swallowing difficulties and regurgitation. The study suggests that patients should be offered both endoscopic and open approaches to manage these pouches, and that performing either approach under one general anesthesia is a practice that surgeons should consider. The study found that the recurrence rates were 15% for endoscopic procedures, 5.9% for open procedures, and 11.7% overall. The document also emphasizes the importance of informed consent and the duty of doctors to discuss all treatment options with patients. It concludes that pharyngeal pouches should be treated in centers with expertise in both open and endoscopic approaches. [Extracted from the article]

Objectives: The aim is to investigate the influence of an active otitis media on the success rate of tympanoplasty in patients with a chronic otitis media (COM) and a tympanic membrane perforation. Databases Reviewed: PubMed, Embase and the Cochrane Library. Methods: The inclusion criteria were studies on closure rates of tympanoplasty performed in COM patients of any age with a tympanic membrane perforation caused by COM. The exclusion criteria were studies on patients undergoing concomitant mastoidectomy, ossicular chain reconstruction, tuboplasty, adenoidectomy, revision tympanoplasty, patients with perforations due to other conditions than COM, and letters to editors, commentaries, conference abstracts and case reports. The included articles were critically appraised using the QUIPS tool. Data on tympanic membrane closure rate were extracted, odds ratio (OR) and 95% confidence intervals (CI) of the closure rate with a wet versus a dry ear were calculated. Results: The search was performed on 1 February 2023. Of 4671 articles, 16 studies were included and critically appraised. Of these observational studies (nine prospective, seven retrospective), with a total of 1509 patients (dry ear group n = 1003; wet ear group n = 506), two studies stated a significant difference in success rate, one in favour of a dry ear and one in favour of a wet ear at time of surgery. All other studies did not show a statistically significant difference. Overall, the risk of bias was considered moderate to high. Conclusions: We found no significant prognostic value of having an active otitis media during tympanoplasty on tympanic membrane closure rates. Because the overall risk of bias was considered moderate to high, no strong conclusions can be made. To be able to answer this question with higher levels of evidence, high‐quality prospective or randomized studies are needed. [ABSTRACT FROM AUTHOR]

Abstract Background Tympanic membrane perforations are among the most common indications for otological surgery. Surgeons from all around the world have made accidental and intentional contributions to find the perfect graft material and the best approach to perform tympanoplasty. Platelet-rich fibrin (PRF) use in myringoplasty has been popular in the last decade among many surgeons. We aimed to evaluate the efficacy of using PRF only as a graft material in myringoplasty. Methods We conducted a prospective study including 20 patients with dry central tympanic membrane perforations. The patients underwent endoscopic transcanal myringoplasty using a platelet-rich fibrin membrane by underlay technique. Follow-up was done 3 months postoperatively regarding graft uptake and hearing outcome by audiological assessment using pure tone audiometry. Results Sixty percent of patients were surgically successful with complete healing of the tympanic membrane, 10% were partially successful with partial healing of the tympanic membrane, and 30% failed with complete loss of graft. The mean air-bone gap closure was 3.5 dB. No major complications were reported. Conclusion Endoscopic myringoplasty using platelet-rich fibrin alone can be performed in cases with tympanic membrane perforations as an alternative to using other autologous grafts. It is a new reliable method for myringoplasty, as well as being an easy, time-saving procedure that avoids the need for any skin incision.

Management of patients with optic nerve sheath meningiomas (ONSMs) is controversial and the treatment strategy in this patient group is still up for discussion. Transnasal endoscopic orbital and optic nerve decompression aims to reduce the pressure in the orbit and on the optic nerve and thereby prevent vision loss. This article presents material from 7 cases of transnasal endoscopic orbital decompression. The study design is a retrospective cohort study. The aim was to include all patients with a meningioma residing along the nerve sheath and who were operated using endoscopic transnasal decompression of the orbit and if needed the optic canal at Odense University Hospital. Data from the medical records were collected and pre- and postoperative eye examinations were compared. In addition, it was recorded whether there were complications to the procedure and whether additional treatments were given. In total, 4 women and 3 men were included in the study. Four out of 7 patients experienced improvement in vision after the operation. One patient experienced unchanged vision and 2 patients experienced deterioration of vision after surgery. The current report of 7 patients with ONSM shows promising results for this surgical procedure as 4 out of 7 patients experienced improvement in their vision at follow-up examinations. The 2 patients who experienced deterioration of vision already had severely reduced vision preoperatively, which indicates that surgery should be considered before the vision becomes significantly reduced. [ABSTRACT FROM AUTHOR]

Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques. Objective In the present work, we evaluate the surgical and audiological outcomes of periosteal graft overlying the mastoid cortex through a retroauricular incision in a pediatric cohort. Methods A retrospective study was carried out involving all children aged ≤ 16 years who underwent periosteal graft myringoplasty for the treatment of chronic suppurative otitis media with dry central perforation in our hospital from April 2019 to April 2021. All patients were followed up for one year to assess the anatomical success and functional outcomes by comparing the preoperative and postoperative (after six months) results of pure tone audiometry (PTA). Results The sample was composed of 36 patients; 20 of them were female (55.6%) and 16 were male (44.4%) subjects, with ages ranging from 7 to 16 (mean: 12.7) years. Four patients underwent surgery in both ears (with an interval of 6 to 9 months). Out of 40 surgeries performed, 38 ears have shown anatomical success (95%). A highly significant improvement in hearing was obtained (the mean difference between the pre- and postoperative results of the PTA was of 14.6 ± 3.45 dB (p < 0.001). Conclusion We advocate the use of periosteal graft in the pediatric population as a good alternative for other types of grafts, with comparable and even better functional and anatomical outcomes. [ABSTRACT FROM AUTHOR]

Background: The current literature supports the closure of trocar sites ≥10‐mm for the risk of developing incisional hernias, while there is no need to suture the abdominal fascia when using 5‐mm trocars. To date, evidence regarding the closure of 8‐mm trocars that are use by new robotic systems is weak. The aim of our study was to investigate the incidence of incisional hernia for 8‐mm trocars. Methods: We prospectively collected data on all patients undergoing robotic‐assisted abdominal wall surgery from 2020 to 2023, in whom the abdominal fascia of all 8‐mm trocars was not closed. The enrolled patients underwent a follow‐up visit during which we conducted clinical and sonographic evaluations of all 8‐mm trocars, in addition to assessing the satisfaction levels of the patients. The primary outcome was the incidence of port‐site hernia. Results: We enrolled 166 patients, 155 men and 11 women, for a total of 513 trocars accessed. Mean age was 61.1 ± 14.0 years, and mean BMI was 27.0 ± 3.9 kg/m2. The follow‐up visits were carried out after a median follow‐up of 14.5 (9.0–23.2) months. Only one case developed an asymptomatic 1 × 1 cm supra‐umbilical hernia that was not treated. Patient reported a satisfaction regarding the 8‐mm trocars and skin sutures of 9.8 ± 0.5 out of 10 points. Conclusions: The occurrence of a trocar‐site hernia after 8‐mm robotic access is extremely low. Hence, the fascia closure may not be necessary. [ABSTRACT FROM AUTHOR]

This article compares two types of external ear canal packing options, Spongostan and Silastic, for endoscopic ear surgery. The study found that there was no statistically significant difference in post-operative healing outcomes between the two dressings. Both dressings were considered viable options for endoscopic ear surgery. The study aimed to fill a gap in the literature regarding packing options for this type of surgery. However, the study has limitations and further research is needed to determine the optimal timing of leaving the Spongostan dressing in place. [Extracted from the article]

Introduction: Fat tympanoplasty is repair of small dry tympanic membrane perforations using fat as graft material. It is a simple office procedure with minimal morbidity and manipulation of the middle ear. Materials and Methods: The present study was a prospective review of 60 patients who underwent fat tympanoplasty over the period of 15 months. In all the patients fat was harvested from ear lobule. Results: Patients were kept on follow up for 3 months and evaluated for graft uptake and hearing gain. 86.66% closure rate of tympanic membrane defect was achieved. Postoperative air conduction was 29.6 ± 5.3 while air bone gap was 13.2 ± 6.1. Conclusion: The study concludes that fat plug myringoplasty is a simple, quick, less invasive method to repair small tympanic membrane defects. [ABSTRACT FROM AUTHOR]

The tympanic membrane forms a barrier between the external auditory canal and the middle ear. In the inactive mucosal type of chronic otitis media, there is a perforation in the tympanic membrane which is surgically managed by Myringoplasty. Estrogen as a growth factor has been shown to have a mitogenic effect on keratinocytes thus hastening the rate of epithelialization following injury. This property of estrogen is being studied in this study for its role in the outcomes of myringoplasty. This study was carried out from January 2021 to December 2022 in the Department of Otorhinolaryngology, of a tertiary teaching hospital in North India. Patients were assessed by history, examination, otoscopy, Audiometry, and oto-endoscopy. A total of 88 patients were taken out of which 44 patients underwent myringoplasty in which topical estrogen (estradiol valerate solution) was used, and the remaining 44 patients were taken as controls. Patients were then assessed post-operatively based on Audiometry results and graft uptake status. In the estrogen group successful Graft uptake was in seen 40 (90.9%) patients and failed in 4 (9.1%), while in the control group, it was successful in 37 (84.1%) patients and failed in 7 (15.9%), statistically there was no significant difference between two groups in terms of graft uptake (p value = 0.334). Post-operatively, in the estrogen group, the mean change in Air Conduction (AC) was 15.5 dB, the change in the air-bone gap (ABG) was 11.5 dB and for Bone Conduction (BC) it was 3.2 dB. However, in the control group mean post-operative changes in Air Conduction, Air-Bone Gap, and Bone Conduction were 12 dB, 10.7 dB, and 0.8 dB respectively. Statistically, there was a significant difference in postoperative changes in AC (p value = 0.011) and BC (p value = 0.009) between the two groups. There was no significant difference in post-operative changes in Air-Bone Gap (p value = 0.571). Topical Estrogen (Estradiol valerate) solution is cost-effective, with enriched growth factors that accelerate tympanic membrane perforation closure following myringoplasty and resulted in significant improvement in hearing thresholds both for Air Conduction and Bone Conduction. [ABSTRACT FROM AUTHOR]

Purpose: To compare the audiological outcomes, tympanic membrane (TM) healing rates and complication rates in patients undergoing endoscopic underlay and over–under tympanoplasty type I (TTI). Methods: The study includes 95 patients who underwent endoscopic TTI in the period between 2018 and 2023: 56% of the patients had the underlay technique and 41% had the over–under technique. Data regarding pre- and postoperative hearing, perforation characteristics, surgical procedures, graft types and complications were retrospectively analyzed. Audiometrical assessment included air conduction (AC) and bone conduction (BC) pure tone averages (PTA) and air–bone gap (ABG), pre- and postoperatively. Results: Both underlay and over–under techniques significant improved AC PTA, with a mean ABG improvements of 5.9 dB and 7.2 dB, respectively. There was no significant difference in BC PTA between pre- and post-operative, indicating no inner ear damage in both techniques. The over–under technique showed a significantly higher TM closure rate (94.4%) compared to the underlay technique (80.6%). Complications were rare, with only one case of TM lateralization requiring revision surgery. Conclusions: Endoscopic TTI is an effective treatment in improving auditory function in chronic middle ear diseases. In our cohort, the detachment of the umbo does not negatively influence the postoperative hearing results and does not increase rate of complications. Moreover, the over–under technique demonstrates superior TM closure rates, making it a valuable option for specific cases. However, future prospective studies with larger sample sizes and longer term follow-up are needed to validate these findings and provide more comprehensive insights. [ABSTRACT FROM AUTHOR]

Cholesteatoma secondary to tympanic perforation, known as "secondary acquired cholesteatoma" may progress slower than a retraction pocket cholesteatoma, with less bone destruction and fewer intracranial complications. However, complete surgical removal remains difficult because the pathological epithelium on the marginal side of the extension is not covered by the subepithelial layer of the cholesteatoma matrix, making the boundary with the middle ear mucosa difficult to identify. Therefore, considering the pathophysiology of secondary acquired cholesteatoma, suitable preoperative evaluation and surgical techniques are required. In this study, we aimed to evaluate (i) the extension of secondary acquired cholesteatoma according to the size and location of tympanic membrane perforation; and (ii) the microscopic surgical outcomes, including the rate of residual cholesteatoma, requirement for specialized surgical management, and changes in hearing. This retrospective study included data of cases with secondary acquired cholesteatoma (n = 66; 66 ears of 64 patients, 2 patients had bilateral ear involvement), including those who underwent a staged operation (n = 25). The perforation level of the tympanic membrane was associated with the cholesteatoma extension. When the cholesteatoma extended around the stapes, staged operation was chosen. Six cases of spontaneous resolution of stapes lesions at the time of staged surgery were observed. A significant postoperative improvement in hearing was observed; however, five cases experienced sensorineural hearing loss. Surgery, including staged surgery of the stapes lesions, along with careful observation of the perforation, is required in secondary acquired cholesteatoma. For lesions that are visible yet challenging to remove, it is imperative to exercise prudent judgment, taking into account the possibility of spontaneous resolution. [ABSTRACT FROM AUTHOR]

Background: The suprageniculate fossa (SGF) is located between the geniculate ganglion, the middle cranial fossa (MCF) and the anterior semicircular canal (ASCC). An endoscopic transcanal approach has been recently proposed to treat the different lesions in this area. The aim of the study is to describe the anatomical pathway of this approach by measuring the dimensions of its boundaries while checking their correlation with the pneumatization of the SGF area. Methods: This is a retrospective anatomical analysis of Cone Beam CT scans of 80 patients, for a total of 160 temporal bones analyzed. Two checkpoints were measured for the SGF route, as an internal and an external window. These are triangles between the MCF dura, the geniculate ganglion and the ASCC on parasagittal and axial planes. The pneumatization of the SGF was also assessed, classified and correlated with the measured dimensions. Results: The depth of the SGF was 7.5 ± 1.8 mm. The width of the external window was 7.5 ± 1.9, 5.6 ± 2.4 and 1.6 ± 1.6 mm for the posterior, middle and anterior points of measurement, respectively. The height of the internal window was 7.6 ± 1.2, 4.5 ± 1.5 and 1.7 ± 1.7 mm for the posterior, middle and anterior points of measurement, respectively. Type A pneumatization was found in 87 cases, type B in 34 and type C in 39. The degree of pneumatization directly correlated to the depth and height of the fossa. Conclusions: The suprageniculate approach route is defined by the internal and external windows which should be evaluated during a pre-surgery imaging assessment. The detailed anatomy of the approach and the novel classification of the pneumatization of the SGF are here described which may be useful to plan a safer procedure with minimal complications. [ABSTRACT FROM AUTHOR]

Objectives: To analyze and compare the available data about the outcomes of endoscopic and microscopic type I tympanoplasty. Data sources: PubMed, Cochrane library Ovid, Scopus, Google scholar, and ClinicalTrials. Methods: We conducted a meta-analysis in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. We included comparative studies describing type I tympanoplasty, and comparing surgical outcomes of the endoscope with the microscope in terms of efficacy and safety. Results: Our systematic search yielded 22 studies meeting the inclusion criteria and eligible for analysis. The pooled graft uptake rates and audiological results of endoscopic and microscopic tympanoplasty demonstrated non-significant differences. In contrast, endoscopic type I tympanoplasty outperforms microscopic tympanoplasty regarding a highly significant decrease not only in pooled mean operative time but also in the pooled complications rate. Conclusions: Based on our meta-analysis, the surgical outcomes of endoscope-assisted and microscope-assisted type I tympanoplasty in terms of postoperative hearing outcomes and the graft uptake rate were comparable. On the contrary, operative time and complications rate proved to be significantly reduced with endoscopy compared to microscopy. Hence, the endoscope is as efficient as the microscope in type I tympanoplasty but less invasive, fewer in complications and shorter in operative time. Key Points: Can the endoscope be a good alternative to the microscope in type I tympanoplasty? Using the microscope in tympanoplasty has been the conventional procedure for repairing perforated tympanic membranes since the 1950s. However, ear surgeons have increasingly practised endoscope-assisted tympanoplasty since the late 1990s. In this study, surgical outcomes of both techniques in terms of postoperative audiological results and the graft uptake rate were comparable. In contrast, the endoscopic technique was superior to the microscopic one in terms of operative time and complications rate. According to our study, the endoscope-Assisted type I tympanoplasty proved to be as effective as the microscopic technique but safer and less invasive. [ABSTRACT FROM AUTHOR]

AIMS AND OBJECTIVES: To Compare the positive predictive value of Jabalpur scoring system and Pulp scoring system, and to study the risk factors influencing the post operative outcome. Materials and methods: It is a prospective study and all patients with peptic ulcer perforation were included in this study. After assessment of various parameters, scoring was done using Pulp and Jabalpur scoring systems. Several investigations namely complete blood count, liver function tests, serum urea and creatinine, chest x ray, ECG, coagulation profile, viral markers, abdomen x ray erect and ultrasound were done. STUDY DESIGN: A prospective observational study. PLACE AND DURATION: Department of General surgery GMC Jammu from 1 November2021 to 31 october 2022. Results: Pulp score is an accurate and significant predictor in predicting mortality and morbidity in patients with peptic ulcer perforation. on applying this scoring system, high risk patients can be optimized and resuscitated in intensive care unit before planning definitive surgery. Pulp score helps surgeons in periphery setup for early referral to tertiary care centers thereby reducing mortality and morbidity. Conclusion: Pulp score is an effective and user friendly scoring system to predict mortality and morbidity in peptic ulcer perforation in developing countries. Pulp score pays more importance to co-morbid history of the patient which plays a very important role in the outcome of patient, thus the Pulp score is comparatively superior to Jabalpur score in predicting mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background: Tympanic membrane perforations are among the most common indications for otological surgery. Surgeons from all around the world have made accidental and intentional contributions to find the perfect graft material and the best approach to perform tympanoplasty. Platelet-rich fibrin (PRF) use in myringoplasty has been popular in the last decade among many surgeons. We aimed to evaluate the efficacy of using PRF only as a graft material in myringoplasty. Methods: We conducted a prospective study including 20 patients with dry central tympanic membrane perforations. The patients underwent endoscopic transcanal myringoplasty using a platelet-rich fibrin membrane by underlay technique. Follow-up was done 3 months postoperatively regarding graft uptake and hearing outcome by audiological assessment using pure tone audiometry. Results: Sixty percent of patients were surgically successful with complete healing of the tympanic membrane, 10% were partially successful with partial healing of the tympanic membrane, and 30% failed with complete loss of graft. The mean air-bone gap closure was 3.5 dB. No major complications were reported. Conclusion: Endoscopic myringoplasty using platelet-rich fibrin alone can be performed in cases with tympanic membrane perforations as an alternative to using other autologous grafts. It is a new reliable method for myringoplasty, as well as being an easy, time-saving procedure that avoids the need for any skin incision. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability.

Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43], P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result. [ABSTRACT FROM AUTHOR]

Background: This study is a prospective cross-sectional study, Six months, starting from July 2020 till December 2020. The sample size was estimated to be 24 cases. As the expected number of patients attending at otorhinolaryngology surgery department and fulfilling the inclusion criteria is about 4 patients /month (24 / 6 months), and all of them were included in the as a comprehensive sample Results: The mean age of cases was 36.42 years (range, 16 – 63 years). Females constituted 58.3% of the study group, whereas the remaining portion was occupied by males. The duration of perforations had a mean value of 2.76 months. Most cases had only one perforation, but overall, their number ranged between 1 and 4. Trauma was the commonest cause in the current study (58.3%), followed by chronic suppurative otitis media (41.7%). The right sided perforations were more prevalent as it was affected in 66.7% of cases.History of ear discharge was positive in 10 cases (41.7%). It was positive in cases with positive history of otitis media. The number of topical insulin installations ranged between 4 and 14 (mean = 8.29). Over the scheduled follow up visits, the perforation size showed a significant decrease from 1.48 mm at baseline down to 0.89, 0.67, and 0.54 at 1-week, 1-, and 2-month visits (p < 0.001). Conclusions: Based on our findings, topical insulin therapy appears to be a hopeful and safe option for small central tympanic perforations, with more favorable outcomes in traumatic versus infective cases. [ABSTRACT FROM AUTHOR]

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability. [ABSTRACT FROM AUTHOR]

Purpose: A variety of lesions could arise from the GG area, or extend into this region from adjacent sites. The management of perigeniculate lesions includes observation, surgery, and radiation, according to the nature, the size of the lesion, and the accompanying symptoms. Preliminary experiences on the exclusive transcanal endoscopic approach to the GG area have shown safety and feasibility avoiding of any postauricular incision, or brain manipulation. The experience from two referral centers on patients treated for a GG lesion with a totally endoscopic approach is herein reported. Methods: Data about patients who underwent exclusive endoscopic approach to the GG area at the Otolaryngology Departments of the University Hospitals of Modena and Bologna between May 2017 and February 2022 were retrospectively collected. Results: The total number of patients included in our study was 11. 10 patients (91%) had progressive unilateral facial paralysis and 1 patient (11%) presented with chronic otorrhea. The mean largest diameter of the treated lesions was of 8 mm. The resection was extended to the fundus of the IAC in 2 patients (expanded approach). The remaining 9 patients (82%) underwent partial ossicular replacement prosthesis (PORP). No major complications occurred. Facial nerve outcomes were good in all patients and the mean ABG worsened from 12 dB pre-operatively to 22 dB post-operatively. Conclusions: The exclusively endoscopic approach to GG lesions represents a viable alternative to traditional microscopic approaches and may be included in the armamentarium of ear surgeons. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the graft outcomes and complications of two endoscopic perichondrium–cartilage graft techniques for repairing large perforations. Study design: Single center blinded randomized controlled trial. Materials and methods: 61 large perforations more than 50% of TM area were prospectively randomized to undergo the free perichondrium and free cartilage graft group (FPFC, n = 31) or perichondrium partial attachment the cartilage graft group (PPAC, n = 30). The primary outcome measures were the operation time; secondary outcome measures were the graft success rate and hearing gain at 12 months postoperatively and postoperative complications. Results: All patients completed follow-up of 12 months. The mean operation time was 38.2 ± 2.3 min in the FPFC group and 37.4 ± 5.6 min in the PPAC group (P = 0.658). At postoperative 3 months, the graft success rates were 96.7% in the FPFC group and 93.3% in the PPAC group (P = 0.976). At postoperative 12 months, the graft success rates were 96.7% in the FPFC group and 83.3% in the PPAC group (P = 0.182). However, the residual and re-perforation rate with no infection was 0.0% (0/31) in the FPFC group and 16.7% (5/30) in the PPAC group (P = 0.056). No significant between-group differences were observed pre- (P = 0.842) or post- (P = 0.759) operative air bone gap (ABG) values or mean ABG gain (P = 0.886). However, granular myringitis has been noted in 6.5% in the FPFC group and in 3.3% in the PPAC group. Conclusions: This study suggested that 12-month graft success and hearing gain were comparable between the perichondrium free and partial attachment the cartilage graft techniques, nevertheless, partial attachment technique could increase residual and re-perforations. [ABSTRACT FROM AUTHOR]

Introduction: Chronic otitis media (COM) with the perforation of the tympanic membrane, myringoplasty is preferred treatment, but if ossicles are involved, myringoplasty is done with ossiculoplasty which is termed as tympanoplasty. Preoperative assessment of ossicular status is important to decide the type of tympanoplasty. Ossicular chain continuity is generally seen in the patient who has short duration of disease and smaller air–bone gap. Our study was conducted to support the relationship between preoperative clinical, audiological, and other factors in relation to the ossicular chain status. Materials and Methods: This was a prospective, cross‑sectional study conducted at a tertiary care center, for 2‑year duration (November 2019 to November 2021), on 100 patients who presented with COM (mucosal type). Preoperative diagnosis and assessment based on the clinical examination and investigations were compared with operative findings. Results: Thirty percent of the patients had ear discharge duration <1 year, 28% had 1–5 years, and 18% patients had 6–10‑year duration. Hearing loss was present in 80% of the cases. Correlation of pure‑tone average (PTA) with ossicular chain status was significant with P = 0.028. The majority of patients were in the moderate category 31% and 19.36% of patients had ossicular chain defect. The second common category was mild hearing loss (24%), of which 4.17% of patients showed ossicular chain defect. Conclusion: Maximum percentages of patients with severe hearing loss had ossicular chain discontinuity followed by profound hearing loss. Most of cases had moderate to moderately severe conductive hearing loss in PTA. As the air–bone gap increases, the possibility of ossicular discontinuity increases. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to determine the efficacy and safety of platelet‑rich plasma (PRP) as an adjuvant for tympanoplasty for perforations of the tympanic membrane with temporalis fascia versus tympanoplasty with temporalis fascia only. Materials and Methods: A total of 100 patients diagnosed with chronic suppurative otitis media tubotympanic type were divided into groups of 50 each. Patients in group one underwent tympanoplasty with PRP, while those in the second group underwent tympanoplasty without PRP. Pre‑ and postoperative graft status and pure‑tone audiometry were performed for all the patients, and the outcomes were compared. Results: Graft uptake in the case group was 90% and while in the control group was 84%. The result was better in cases that underwent tympanoplasty with PRP. The improvement in the A‑B gap was significantly more in the case group as compared to that of the control group. Conclusion: Temporalis fascia graft alone and along with PRP, both techniques has excellent results. The use of PRP along with temporalis fascia in cases of large central perforation gives an additional benefit in respect to healing time and audiological gain. [ABSTRACT FROM AUTHOR]

Background: Robotic-assisted surgery is steadily becoming more prominent. The majority of reports regarding port site hernias (PSHs) have involved laparoscopic procedures. Currently, it is common to suture the fascia at port sites that are 10 mm or larger; however, the closure of 5-mm port sites is not considered mandatory. The da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) utilizes a distinctive 8-mm port. We report a case of an early-onset PSH at an 8-mm port site after robotic-assisted ileocecal resection. Case presentation: A 74-year-old male patient with a body mass index of 19.7 kg/m2 was diagnosed with cecal cancer and underwent robotic-assisted ileocecal resection. A 3-cm midline incision was made at the umbilicus for insufflation. Under laparoscopic visualization, three ports (12 mm, 8 mm, and 8 mm) were inserted in the lower abdomen. An 8-mm port was inserted in the left subcostal region, and a 5-mm port was inserted in the left lateral abdomen. The procedure was performed without significant intraoperative complications. The fascia was closed only at the umbilicus and 12-mm port site; the fascia at the 8-mm port sites was not closed. The patient was initially discharged without complications; however, on postoperative day 11, the patient was urgently hospitalized again because of PSH incarceration. After manual reduction, the fascia was sutured closed under local anesthesia. The hernial defect was small and barely allowed the insertion of a little finger. There was no evidence of compression or significant damage to the fascia. On postoperative day 27, the patient was discharged after experiencing good recovery. Conclusions: Robotic-assisted colectomy could contribute to the risk of PSHs because of its surgical characteristics. Although routine closure of the fascia at 8-mm port sites is not mandatory, it may be beneficial in certain cases. [ABSTRACT FROM AUTHOR]

Background: Myringoplasty is the most effective method for the closure of chronic tympanic perforations, fat graft as support for epithelialization has a low success rate for perforations > 30%, the use of platelet-rich plasma promises an adjuvant role in the regeneration of the tympanic membrane in perforations > 25% and <50%. Objective: To demonstrate the rate of successful of myringoplasty with fat graft with platelet-rich plasma in tympanic membrane perforations less than 50% compared to fat graft alone. Material and methods: Clinical, randomized, controlled study. 60 patients were included with perforation of less than 50%, both sexes, without active infection, suspicion of ossicular pathology or history of mastoidectomy. Divided into two groups: Group A, 30 patients who underwent myringoplasty with fat graft and Group B, 30 patients with the same technique and platelet-rich plasma. Groups were subdivided by perforation size: Subgroup 1 (0-25%) and Subgroup 2 (26-50%). Results: At one month of postsurgical follow up, the tympanic membrane perforation closure success rate was significantly higher in group B compared to group A, p = 0.047. Subgroup 1: closure of 56% and 66.6% for group A and B, subgroup 2: with 0 and 13%. Conclusions: Myringoplasty with fat graft with platelet-rich plasma enriched is recommended as a treatment option for first line of medium-sized tympanic perforations. [ABSTRACT FROM AUTHOR]

Introduction: We performed two surgical techniques for primary irreparable rotator cuff tears: a patch technique using the femoral fascia as a graft (F technique) and a patch technique using the bony iliotibial ligament (I technique). We then evaluated the outcomes of both surgical methods. Materials and methods: This study included 28 patients who were diagnosed with primary irreparable rotator cuff tears from April 2008 to April 2014. Among them, 13 underwent the F technique, whereas 15 underwent the I technique. Each clinical shoulder score was evaluated preoperatively and 2 years after surgery. The cuff integrity was evaluated via magnetic resonance imaging 2 years after surgery, with cases suffering a retear after surgery undergoing retear site examination. In group I, computed tomography (CT) was performed 3–4 months after surgery to investigate the bony part of the patch and bony fusion of the footprint. Results: Both groups showed significant improvements in the pre- and postoperative mean clinical score values. Group I had significantly better postoperative scores than group F. Postoperative retear rates were 33.3% and 76.9% for groups I and F, respectively, with group I having a significantly lower retear rate (P = 0.03). All 5 retears in group I were located at the suture between the residual rotator cuff and the graft, whereas 7 of the 10 retears in group F were located at the fixation of the graft and footprint and the remaining 3 were central. CT results in group I showed that all 15 patients had bony fusion between the bony part of the patch and the footprint. Conclusion: The I technique was significantly superior to the F technique in terms of postoperative clinical scores and retear rates, suggesting its advantage for rotator cuff tissue reconstruction. [ABSTRACT FROM AUTHOR]

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process. [ABSTRACT FROM AUTHOR]

Background: Chronic Otitis Media (COM) is a persistent inflammatory condition affecting the middle ear, characterized by symptoms such as ear discharge, tympanic membrane perforation, and hearing loss. Its prevalence, particularly high in developing countries like India, is influenced by socioeconomic factors and inadequate nutrition. This study aimed to evaluate graft uptake rates and hearing improvement in COM patients undergoing myringoplasty, regardless of ear moisture status. Additionally, the study sought to assess the impact of combining myringoplasty with cortical mastoidectomy on surgical outcomes. Methods: A prospective study was conducted at a tertiary Medical College in south India, from November 2021 to September 2023. Sixty patients with active and inactive mucosal type chronic otitis media were enrolled, with 30 patients in each group (dry and wet ears). Surgical procedures were performed based on individual patient characteristics, and outcomes were evaluated through graft uptake rates and hearing improvement. Results: Successful closure of tympanic membrane perforations was observed in both wet and dry ears, with comparable success rates of 89.65% and 96.67%, respectively. Graft uptake rates did not significantly differ between the two groups, suggesting similar outcomes irrespective of ear moisture status. While hearing gain was slightly lower in patients with wet ears compared to those with dry ears, the difference was not statistically significant. Conclusion: Myringoplasty remains an effective treatment for tubotympanic chronic suppurative otitis media, with comparable success rates in wet and dry ears. Factors such as age, sex, perforation size, and mastoid pneumatization did not significantly influence surgical outcomes. Cortical mastoidectomy, when warranted, may contribute to improved outcomes, particularly in cases of active disease. This study emphasizes the importance of thorough preoperative evaluation and patient selection in achieving favorable surgical results. [ABSTRACT FROM AUTHOR]

Aim & objectives: To assess the outcome of Fat Myringoplasty (FM) as an office procedure for small central perforation with respect to graft uptake, hearing improvement & complications Methodology: This prospective study was carried out in Department of Otorhinolaryngology, Dr Sushila Tiwari Hospital Haldwani for a period of one year from April 2021 to April 2022. All patients attending the ENT OPD between the age group of 16-60 years with complaints of ear discharge and decreased hearing were screened by detailed history, clinical examination and otoendoscopy. All patients having COM with small dry central perforation in pars tensa i.e less than 25%-30% of pars tensa in any quadrant with dry perforation for at least 3 weeks, persistent perforation for >6 months and normal appearance of middle ear mucosa with PTA showing AB Gap of <30db were included in the study. Result: The overall successful graft uptake rate was found to be 75 % at the end of 3rd month. The mean difference between Pre op PTA and Post op PTA along with the mean difference between Pre op AB gap and Post op AB gap was found to be significant. Conclusion: Fat myringoplasty is considered as a safe and effective procedure. It can be easily performed for closure of small dry central perforation of TM. And performed as an office procedure, and the patient can be discharged on the same day. Bilateral surgery is also possible and postoperative care required is minimal. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to evaluate the graft outcomes of endoscopic perichondrium-cartilage myringoplasty with preserving of anterior margins for repairing anterior perforation with 3 year followup. Study design: Prospective case series. Setting: Tertiary university hospital. Materials and Methods: We performed a prospective study in 47 patients with anterior perforation who underwent perichondrium-cartilage myringoplasty with preserving of anterior margins and tuck grafts. The operation time, graft success rate, hearing outcome, and complications were evaluated at 6 months and 3 years after surgery. Results: A total of 47 ears with anterior marginal perforation were included in the study. The perforation size was subtotal in 2 (4.3%) eras, large in 11 (23.4%) ears, medium in 27 (57.4%) ears, and small in 7 (14.9%). The mean operation time was 41.2 ± 5.4 minutes. All patients completed 6 months of follow-up. Residual perforation was observed in 2 patients with medium perforations, the graft success rate was 95.7% (45/47). The mean preoperative and postoperative AC PTAs were 38.1 ± 7.3 dB and 25.4 ± 4.6 dB (P <.05), while the mean preoperative and postoperative BC PTAs were 9.0 ± 4.6 dB and 9.6 ± 1.9 dB (P =.672). The functional success was 91.5% (43/47). None of the patients reported sensorineural hearing loss, altered taste, facial nerve palsy, vertigo, or tinnitus during the follow-up period. In addition, 34 (72.3%) patients completed 3 years followup and performed temporal bone CT examination, the mean followup time was 39.1 ± 2.7 months, CT revealed the well pneumatization of mastoids and middle ear. Conclusions: Endoscopic perichondrium-cartilage myringoplasty with preserving of anterior margins and tuck grafts is a safe, suitable, and reliable method for repair of anterior perforation with few risk of anterior blunting and lateralization. [ABSTRACT FROM AUTHOR]

Objective: This study was performed to compare the operation time, graft outcomes and complications between the endoscopic cartilage-perichondrium button technique and over-under technique for repairing large perforations. Methods: A total of 52 chronic large perforations were randomly allocated to receive treatment using the endoscopic cartilage-perichondrium button technique (n = 26) or over-under technique (n = 26). The graft outcomes, mean operation time and post-operative complications were compared between the two groups at 12 months. Results: The study population consisted of 52 patients with unilateral chronic large perforations. All patients completed 12 months of follow up. The mean operation time was 32.3 ± 4.2 minutes in the button technique group and 51.6 ± 2.8 minutes in the over-underlay technique group (p < 0.01). The graft success rate at 12 months was 92.3 per cent (24 out of 26) in the button technique group and 96.2 per cent (25 out of 26) in the over-underlay group (p = 0.552). Conclusion: The endoscopic cartilage-perichondrium button technique had similar graft success rates and hearing outcomes for large chronic perforations to the over-under technique, but significantly shortened the mean operation time. [ABSTRACT FROM AUTHOR]

Introduction Myringoplasty is a common otologic procedure to restore the integrity of the tympanic membrane in cases of traumatic or pathologic perforations. Many grafting materials have been used with different techniques.

Abstract Objective This study evaluated the graft success rate and hearing outcomes of the inside-out raising mucosal-tympanomeatal flap technique for the repair of large marginal perforations. Study design Prospective case series. Materials and methods The study enrolled patients with large marginal perforations who underwent endoscopic cartilage myringoplasty with the inside-out raising mucosal-tympanomeatal flap technique. The graft success rate, hearing outcomes, and complications were evaluated at 12 months postoperatively. Results In total, 48 patients with large marginal perforations were included. 81% of the population had large perforation, 14.6 had subtotal and total perforation was seen in 4.2%. The mean operation time was 38.6 ± 7.1 min. At 12 months postoperatively, the graft success rate was 89.6% (43/48). The mean air-bone gap was 25.6 ± 5.2 dB preoperatively and 16.5 ± 4.1 dB at 12 months postoperatively, with significant differences between these values (p = 0.001). The functional success rate was 85.4% (41/48). None of the patients experienced worsened sensorineural hearing loss or graft-related complications, such as graft lateralization, significant blunting, and graft medialization, during follow-up. Conclusions Endoscopic cartilage-perichondrium myringoplasty for the repair of large marginal perforations using the inside-out raising mucosal-tympanomeatal flap technique was associated with satisfactory graft outcomes and minimal complications.

Objective: To clarify the influence of eustachian tube (ET) anatomical measurements on the success rate of Type 1 cartilage tympanoplasty. Material and Methods: The medical records of 99 patients, who underwent cartilage Type 1 tympanoplasty were reviewed retrospectively. The length of ET (ETl), tubotympanic angle (TTa), ET-Reid horizontal plane angle (ETa), and ET pretympanic diameter (ETd) were measured on temporal bone computed tomography using the multiplanar reconstruction technique. Two groups were created based on the anatomical success of the procedure. Group 1 consisted of ears with successful anatomic outcomes and Group 2 consisted of ears without successful anatomic outcomes a year postoperatively. The ET anatomical measurements of Groups 1 and 2 were compared. Results: A total of 108 ears (90 unilateral and 9 bilateral ears of 99 patients) were included in our study. The differences between the ETl, TTa, ETa, and ETd of Groups 1 and 2 were statistically insignificant. Conclusion: Our study showed that ETl, TTa, ETa, and ETd do not have a significant role in the anatomic outcome of Type 1 cartilage tympanoplasty. Using cartilage grafts in Type 1 tympanoplasty might be preferred to rule out the anatomical disadvantages regarding the ET. Studies with greater sample sizes are required to assess both the anatomy and function of the ET in the success rate of Type 1 tympanoplasty with various graft types. [ABSTRACT FROM AUTHOR]

Various transcatheter interventions for the right ventricular outflow tract (RVOT) have been introduced and developed in recent decades. Transcatheter pulmonary valve perforation was first introduced in the 1990s. Radiofrequency wire perforation has been the approach of choice for membranous pulmonary atresia in newborns, with high success rates, although complication rates remain relatively common. Stenting of the RVOT is a novel palliative treatment that may improve hemodynamics in neonatal patients with reduced pulmonary blood flow and RVOT obstruction. Whether this option is superior to other surgical palliative strategies or early primary repair of tetralogy of Fallot remains unclear. Transcatheter pulmonary valve replacement has been one of the biggest innovations in the last two decades. With the success of the Melody and SAPIEN valves, this technique has evolved into the gold standard therapy for RVOT abnormalities with excellent procedural safety and efficacy. Challenges remain in managing the wide heterogeneity of postoperative lesions seen in RVOT, and various technical modifications, such as pre-stenting, valve ring modification, or development of self-expanding systems, have been made. Recent large studies have revealed outcomes comparable to those of surgery, with less morbidity. Further experience and multicenter studies and registries to compare the outcomes of various strategies are necessary, with the ultimate goal of a single-step, minimally invasive approach offering the best longer-term anatomical and physiological results. [ABSTRACT FROM AUTHOR]

Purpose: Facial nerve decompression (FND) for traumatic facial palsy with lesion at geniculate ganglion and tympanic segment can be done through transcanal approach, by a microscope or an endoscope without opening the mastoid. The study analyzes the outcomes of transcanal endoscopic approach (TEA) for FND with regard to improvement in facial nerve (FN) function and hearing status, in lesions limited to perigeniculate and tympanic segment of FN. Methodology: This was a retrospective analysis of the case series from a tertiary care center, of the patients with posttraumatic FN paralysis, surgically treated with TEA. From January 2014 to December 2018, nine patients of traumatic facial palsy were selected for surgery. The patients posted for surgery were selected only when they had immediate-onset FN paralysis after trauma and not responding to treatment of systemic corticosteroid for 14 days with, House Brackmann grading (HBG) IV-VI, lesions confined to perigeniculate ganglion and tympanic segment of FN. Outcome analysis following TEA for FND was performed in terms of postoperative FN function and hearing improvement. Results: The TEA showed a postoperative improvement of FN function (HBG I/II) in 77.7% of patients within 6-month follow-up period. There was no significant improvement in FN function between 6th and 12th month. Postoperative hearing improvement was seen in eight cases, and there was no improvement in one case due to preoperative sensorineural hearing loss. Conclusion: TEA for FND is a direct approach for lesions confined to perigeniculate ganglion area and tympanic segment without involvement of mastoid segment of FN. It requires minimal bone drilling, provides proper visualization, and accurate surgical site assessment. Surgeries performed even in late presentations may have favorable outcomes. [ABSTRACT FROM AUTHOR]

Objectives: In 2001, we instituted a protocol for the removal of retained tympanostomy tubes, delaying elective removal until 2.5 years after placement. It was hoped that this would decrease the number of surgeries without increasing the rate of permanent tympanic perforations compared to removal at 2 years. Methods: Protocol: Fluoroplastic Armstrong beveled grommet tympanostomy tubes were placed by a single surgeon supervising the residents. The children were seen at 6‐month intervals after placement. Children with a retained tympanostomy tube(s) at 2 years were seen again at 2.5 years, and the retained tubes were removed under general anesthesia with patch application. All were evaluated 4 weeks after surgery by otoscopy, otomicroscopy, behavioral audiometry, and tympanometry. Study: A computerized collection of patient letters and operative reports was queried to identify children treated according to the protocol between 2001 and 2022. Those with examinations at 2 years ± 1 month and 2.5 years ± 1 month and complete follow‐up were included. Results: Of the 3552 children with tympanostomy tubes, 497 (14%) underwent tube removal. One‐hundred and forty seven children fit the strict inclusion criteria. Among those with retained tubes at 2 years, 67/147 (46%) had lost any remaining tube or tubes at 2.5 years and did not need surgery, 80/147 (54%) required unilateral or bilateral tube removal, 9/147 (6%) had a persistent perforation at 1‐year follow‐up, and 4/147 children (3%) required tympanic re‐intubation after either spontaneous extrusion or removal and patching at 2.5 years. Conclusions: Delaying tympanostomy tube removal until 2.5 years can cut the need for surgery in half with, an acceptable (6%) incidence of persistent perforations. Level of Evidence: Four case series—historical control Laryngoscope, 134:439–442, 2024 [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the graft outcome and postoperative infection of with and without the use of antibiotic ointment following myringoplasty for the treatment of chronic perforations. Study Design: Randomized controlled trial. Material and Methods: 135 chronic perforations were prospectively randomized to use of antibiotic ointment group (UAO, n = 68) or no use of antibiotic ointment group (NAO, n = 67) following myringoplasty. The graft outcomes and postoperative infection were compared among two groups at 6 months. Results: At postoperative 6 months, the graft infection rate was 4.4% in the UAO group and 10.4% in the NAO group, the difference was not significant (P = 0.312).The graft success rates were 92.6% in the UAO group and 91.0% in the NAO group, the difference was not significant (P = 0.979). In the UAO group, 3 patients with purulence ear discharge resulted in a residual perforation although they received ofloxacin ear drops and intravenous antibiotic therapy treatment. In the NAO group, 6 patients with purulence ear discharge resulted in a residual perforation, only one, with mild purulence discharge was successfully treated and closed. In addition, no significant between-group differences were observed pre- (P = 0.746) or post- (P = 0.521) operative air bone gap (ABG) values or mean ABG gain (P = 0.745). However, granular myringitis with minimal moistness but without infection has been noted in 3 (4.4%) patients in the UAO group and in 5 (7.5%) in the NAO group, the difference was not significant (P = 0.699). Conclusions: Use and non-use of antibiotic ointments for lateral packing of graft are both comparable methods following myringoplasty for postoperative infection and graft outcomes. [ABSTRACT FROM AUTHOR]