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Purpose: To perform a systematic review and meta-analysis exploring the effectiveness of porcine small intestinal submucosa (pSIS) compared with autologous grafts for tympanic membrane perforation repair. Methods: A prospective meta-analysis protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews) on June 5th, 2024, under protocol CRD42024551979. PubMed, Embase/Ovid and Cochrane Central databases were searched from inception to 28/05/2024 for studies comparing the use of pSIS versus autologous grafts (perichondrium, cartilage, temporalis fascia or cartilage-perichondrium) for tympanic membrane perforation repair. The outcomes evaluated were persistent perforation after surgery, operative time and hearing outcome. Statistical analyses were performed using the online Review Manager (Cochrane Collaboration). A subgroup analyses were carried out for the paediatric population. Results: We included 1,407 patients (1447 ears) from seven records; six retrospective cohort studies and one randomised controlled trial (RCT). pSIS graft was used in 563 ear surgeries (38.1%). Four studies included children with a mean age ranging from 7.3 to 11.7 years and the other 3 studies included adults with a mean age ranging from 30.8 to 48.4 years. Follow-up ranged from 2 to 132 months. There was no statistically significant difference in the failure rate (persistent perforation) between pSIS graft and autologous graft (RR 0.95; 95% CI 0.67–1.33; p = 0.76). However, reduced operative time was associated with using pSIS grafts (MD -16.12 min; 95% CI -22.94-9.31; p = < 0.00001). Conclusion: Tympanic membrane perforation repair with pSIS grafts had a similar failure rate and hearing outcome compared to autologous grafts and demonstrated an association with reduced operative time. [ABSTRACT FROM AUTHOR]

Introduction: Perforations of the tympanic membrane result mainly from otitis media or trauma, and we need grafting when a perforation is chronically persistent to prevent recurring infections and to enhance hearing. In the present study, we assessed the success rate, feasibility, and efficacy of endoscopic transcanal tympanoplasty using tragal cartilage grafts via the clip technique. Methods: This prospective study was performed between September 2017 and December 2021 and was conducted in ENT departments in tertiary hospitals. Forty patients underwent endoscopic clip technique tragal cartilage type 1 tympanoplasty. Patients with dry (for 3 months at least) small (less than 3 mm), medium (3-5 mm), or large (more than 5 mm) central perforations but not marginal perforations. Results: TM perforation healing following the procedure for 6 months was achieved in 100% of the patients with small perforations, 18 of 19 (94.73%) with medium perforations and 11 of 12 (91.6%) with large perforations. At 6 months post-surgery, hearing improvement, as confirmed by audiometric results, was approximately 12.41 ± 1.01 dB. There was a highly significant improvement in the A-B gap (air-bone gap). Conclusion: Endoscopic chondro-perichondrial tragal graft with the clip technique for the repair of small-, medium-, and large-sized nonmarginal TM perforations is a minimally invasive, safe and effective technique compared with the conventional myringoplasty technique. It provided good results (closure of both the perforation and the air-bone gap), minimized morbidity, reduced the operative time, increased patient compliance, and reduced the duration of hospital admission. [ABSTRACT FROM AUTHOR]

The article discusses the use of an Endoscopic Integrated Multipoint Laser System (EIMLS) to measure anterior skull base defects with precision. The study found that EIMLS can provide quick, precise, and objective measurements of these defects, showing promise for use in endoscopic surgical techniques. However, further refinement of the measurement technique is needed before implementing it in clinical practice. The technology has the potential to be valuable in otorhinolaryngology and broader endoscopic surgical applications. [Extracted from the article]

Background: To prospectively determine whether tympanoplasty for tympanic membrane perforation (TMP) in wet ears impacts recovery. Methods: We prospectively enrolled 32 TMP patients (2021–2023) and divided them into the wet-ear (14 patients) and dry-ear groups (18 patients), according to the presence of middle-ear secretions/edema. All patients underwent high-resolution thin-slice computed tomography, ear endoscopy, and pure tone audiometry. Results: Perforation healing was similar in the dry- ear (94.44%) and wet-ear groups (85.7%, P = 0.5685). At 3 months, dry ears were achieved in 94.44% and 92.86% of patients in the dry- and wet-ear groups, respectively (P > 0.05). The air-bone gap (ABG) at 3 months was similar in the dry-ear (9.4047 ± 4.3415 dB) and wet-ear groups (6.5278 ± 5.4552 dB, P = 0.1171). In both groups, the mean air-conduction threshold, bone-conduction threshold, and ABG significantly decreased postoperatively (P < 0.05). Conclusion: Tympanoplasty for TMP in wet ears does not adversely affect healing. [ABSTRACT FROM AUTHOR]

Aims and objectives: To study the clinical status of contralateral ear in cases of unilateral CSOM. Introduction: In the medical field, understanding the clinical status of the contralateral ear in cases of unilateral Chronic Suppurative Otitis Media (CSOM) is crucial for effective treatment. This study was conducted at Shri Maharaja Ghulab Singh Hospital in Jammu, India from November 2020 to October 2021, involving 105 patients who met the inclusion criteria. Materials and methods: A thorough examination was carried out, including taking a detailed history of symptoms such as hearing loss, discharge, vertigo, tinnitus, and pain. An ENT examination was conducted, assessing the pinna, external auditory canal, tympanic membrane, and ossicles. Otoendoscopic examination of the ear and diagnostic nasal endoscopy were also performed to rule out any nasal pathology. Results: Out of 105 patients in our study, 61 were females and 44 were males. The main presenting symptoms were ear discharge alone in 84 patients followed by associated hearing impairment in 15, and 6 patients had tinnitus. Among 105 patients, the duration of ear discharge from > 5 years was seen in 36 patients, followed by 1–2 years in 29 patients, 2–5 years in 22 patients, and from < 1 year in 18 patients. Ninety-five patients were diagnosed to have mucosal COM and 10 had active squamosal disease. Thirty-four patients had subtotal perforation of pars tensa in the ipsilateral diseased, 26 patients had medium-sized perforation, 18 patients had small-sized perforations, 12 had large perforation, 10 had attic perforation, and 5 had total perforation. Thirty-four patients had a normal tympanic membrane of the contralateral ear and abnormalities of contralateral tympanic membrane were seen in 71 patients. Eighty-eight patients had deviated nasal septum on DNE. Among 105 patients, PTA assessment showed that 103 patients had a conductive hearing loss in the diseased ipsilateral ear. B type tympanogram was found in 70 diseased ears and the contralateral ear of those patients showed A type tympanogram in 20 and B-type tympanogram in 50 ears. C type tympanogram was seen in 35 diseased ears and the contralateral ear of those patients showed A type tympanogram in 12 patients and C type tympanogram in 23 patients. Contralateral mastoid X-ray showed well pneumatization in 45 patients followed by diploic type of pneumatization in 55 patients and sclerotic mastoid in 5 patients. Conclusion: The findings of this study emphasize the importance of considering both ears in the treatment of CSOM. It is crucial to educate patients about the potential bilateral effects of the disease for proper therapy planning. This study sheds light on the significance of examining the contralateral ear in patients with unilateral CSOM. Understanding the clinical status of both ears can lead to more comprehensive treatment strategies and better outcomes for patients. [ABSTRACT FROM AUTHOR]

Numerous materials have been used to reconstruct the tympanic membrane and restore its mechanical and vibratory properties with varying degrees of success. If endoscopic ear surgery is to be considered "minimally invasive," it must avoid any unnecessary incision or scarring. The biomaterials currently used in surgery, therefore, have their place in this recent approach to ear surgery. [ABSTRACT FROM AUTHOR]

Alongside the historical use of the microscope, endoscopic ear surgery has been developed for several years. Its advantages are now widely recognized, for example its wider view and its clear superiority to detect "hidden cholesteatoma". However, its use remains restricted to some teams, and its indications and applications are still debated in the otologist community. This review of the literature presents advantages, results, and limitations of both approaches. Moreover, the article highlights current evidence of equivalence or superiority of one of the other approach according to the different otologic surgical procedures. However, more studies about endoscopic ear surgery are required with longer follow-up and larger sample size. Finally, authors proposed a decision-making tree to guide the ear surgeon to the best practice. [ABSTRACT FROM AUTHOR]

When an ENT surgeon plans on starting the endoscopic technique for ear surgery, type I tympanoplasty is the first intervention to master. We wish to discuss the advantages and difficulties of the use of the endoscope, and offer a description of type I tympanoplasty as we realize it. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate the relationship between air-bone gap (ABG) and wideband absorbance (WBA) values in patients with conductive hearing loss resulting from four middle ear pathologies: Tympanic membrane perforation, middle ear effusion, ossicular chain discontinuity, and otosclerosis. Methods: Air and bone conduction thresholds and WBA values were measured at 0.25, 0.5, 1, 2, and 4 kHz under ambient pressure. Correlations between ABG and WBA were analyzed in each pathology group to explore diagnostic relevance. Results: Significant correlations were identified for specific frequencies and pathologies. In the middle ear effusion group, ABG was negatively correlated with WBA at 0.25 kHz in the right ears (r=-0.570, p=0.022), whereas a positive correlation was observed in the otosclerosis group at the same frequency (r=0.570, p=0.048). Additionally, a negative correlation was noted at 4 kHz for the left ears across all groups (r= -0.270, p= 0.034). Conclusion: Preoperative WBA measurements provide valuable insights into middle ear function, offering diagnostic and surgical planning advantages for patients with conductive hearing loss. These findings suggest incorporating frequency-specific WBA evaluations into clinical practice can enhance the precision of middle ear pathology assessments. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the opposite ear in patients operated for chronic otitis media (COM).Methods: In a cross-sectional study involving three tertiary hospitals, patients who underwent surgery for COM were examined for abnormalities of the contralateral ear at the time of the surgery. Results: Out of 228 patients, 182 (79.8%) were operated on for non-cholesteatomatous or simple chronic pars tensa perforation of the tympanic membrane (PTP), and 46 (20.2%) for cholesteatoma. 113 (49.56%) patients had normal contralateral ears under oto-microscopic exam. PTP was statistically more prevalent in females than males (F/M:118/64), whereas cholesteatoma was more prevalent in males (21/25). In the PTP group, 82 (45.3%) had normal contralateral ears, whereas patients with cholesteatoma had 31 (67.4%) normal opposite ears (P = 0.01). The most frequent abnormal findings in the PTP group were pars tensa perforation and sclerotic plaques, and in the cholesteatoma group were cholesteatoma and pars tensa perforation. Patients with cholesteatoma had significantly lower contralateral ear perforation than patients with tympanic membrane perforation (P = 0.02). The most frequent size of eardrum perforation in the contralateral ear of the PTP group was more than 50 percent. No significant difference existed between the large and small perforations for contralateral abnormality. Conclusion: Bilateral pathophysiology seems to be more prominent in PTPs than in cholesteatomas. Tympanic membrane perforation tends to be accompanied by a large perforation. The larger perforation on one side did not predict having more problems on the opposite side. [ABSTRACT FROM AUTHOR]

Skull base osteomyelitis (SBO) is a rare and lethal infection of temporal bone, uncommonly caused by purulent otitis media. Although uncommon, a young and immunocompetent person is not exceptional to develop SBO as in our case. We reported a case of SBO in a young, immunocompetent gentleman who presented with right otorrhea associated with fever, trismus, headache, and neck stiffness, which was unresponsive to oral and topical antibiotics. Examination revealed fullness at the right mastoid tip with no evidence of mastoid abscess, trismus, with restrictions of neck movements. Otoscopy of right ear showed mucopus with 10% anterosuperior tympanic membrane perforation without keratin or granulation tissue. Pus for culture and sensitivity grew Klebsiella pneumonia and computed tomography (CT) showed osteomyelitic changes with associated parapharyngeal collection. The patient was started on intravenous antimicrobial therapy and responded well to the treatment. [ABSTRACT FROM AUTHOR]

Cartilage perichondrium composite grafts (CPCG) have been used in tympanoplasty for many years. Reperforations can be seen because of various problems. The aim of our study is to describe a graft technique to minimise the complications and to evaluate the success of the graft. The ears which underwent type 1 tympanoplasty using CPCG were included in the study. Over-underlay graft technique was used in all operations. They were performed by microscopic transcanal approach and by the same surgeon. Fifty-four ear operations of 48 patients were included in the study. While the preoperative average pure tone- average (PTA) of the ears was 45 (21–75) dB, the postoperative average PTA was 28 (11–58) dB. While the preoperative air bone gap (ABG) of the ears was 23.3 (10-43.3) dB, the postoperative ABG was 11.6 (0-28.3) dB. A significant improvement was achieved in both ABG and PTA values after the operation (p < 0.001). The graft success rate was 94.4%. The cartilage graft modifications such as block cartilage, palisade, cartilage island and butterfly have been applied successfully. We aimed to reduce the risk of reperforation, maximise audiological gain and facilitate the follow-up of postoperative middle ear pathologies by thinning the cartilage island and extending the perichondrium to the external auditory canal in the modification of CPCG. The graft success rate and the audiological success rate are high enough to be compared with the literature. The described CPCG can be used safely in all types of perforations, especially in high-risk perforations. [ABSTRACT FROM AUTHOR]

Purpose: During endoscopic ear surgery (EES), it is important to maintain a clear view of the endoscopic camera to achieve a clean field. In this study, a self-expandable external auditory canal (EAC) retainer was developed to enable a more efficient and safer EES. This study aimed to evaluate the retainer's efficacy and safety in EES. Methods: Among adult patients scheduled for endoscopic tympanoplasty, 50 participants were recruited. They were assigned to either the retainer or control group in a 1:1 ratio. The anatomical characteristics, number of endoscopic cleanings during surgery, surgeon's satisfaction, and other factors were evaluated. Results: No differences were observed in the surgical direction, EAC size measured on preoperative temporal bone computed tomography scans, location and size of tympanic membrane perforation, or bleeding degree between the two groups. When comparing the surgical time, including retainer insertion and removal, the time was similar between groups (retainer group, 35 min; control group, 33.2 min). The frequency of endoscopic cleaning per minute was statistically significantly lower in the retainer group than in the control group (0.18 times per minute, p = 0.048). No side effects, including sensory abnormalities or allergic reactions, were reported in any patient who used the retainer. Conclusion: A reduction in unnecessary endoscopic cleaning during EES was observed while using the self-expandable retainer, leading to increased surgeon satisfaction and efficiency. Furthermore, as a safe method without side effects, the retainer could be widely used to various indications for EES beyond tympanoplasty. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the functional and clinical outcomes of endoscopic Type 1 tympanoplasty in patients with chronic otitis media and tympanic membrane perforations, focusing on hearing improvement and graft success rates. Methods: This retrospective study included 46 patients with dry tympanic membrane perforations who underwent endoscopic Type 1 tympanoplasty. Audiometric data, including pure tone averages (PTA) and air-bone gap (ABG) measurements at four frequencies (500, 1000, 2000, and 4000 Hz), were collected preoperatively and postoperatively. Functional success was defined as a postoperative ABG of 20 dB, whereas the integrity of the graft determined clinical success. Results: The mean preoperative ABG was 36.74±7.62 dB, which significantly improved to 15.05±3.82 dB postoperatively (p<0.001). The PTA exhibited an average gain of 28.17±6.87 dB for all frequencies. Functional success was achieved in 42 patients (91.30%), with 17 patients (36.96%) achieving normal hearing and 22 patients (47.83%) presenting with slight hearing loss postoperatively. Anatomical success was achieved in 42 patients (91.30%). Conclusions: Endoscopic Type 1 tympanoplasty is a safe and effective surgical method for treating chronic otitis media, with high rates of both functional and clinical success, significant improvements in hearing outcomes, and minimal postoperative complications. [ABSTRACT FROM AUTHOR]

Introduction Platelet-rich plasma (PRP) contains high platelet concentration and growth factors that help in rapid wound healing, hemostasis, and decreased scarring. It has been used in various conditions to aid in healing, but its use in ear, nose, and throat (ENT) is not yet common.

Samuel J Martin,1 Phaibun Chiraphatthakun,2 Anan Samson Keereemalee,2 Wirachat Chiraphatthakun,2 Robert W Arnold2– 4 1Loma Linda University School of Medicine, Loma Linda, CA, USA; 2Jungle School of Medicine Kawthoolei, the Free Burma Rangers, Kawthoolei, Karen State, Burma; 3Alaska Blind Child Discovery, Alaska Children’s EYE & Strabismus, Anchorage, AK, USA; 4Ophthalmology Department Consultant, Providence Alaska Medical Center (1989-2024), Anchorage, AK, USACorrespondence: Robert W Arnold, Alaska Children’s EYE & Strabismus, 3500 Latouche Street &num;280, Anchorage, AK, 99508, USA, Tel +1 (907)561-1917, Fax +1 (907)563-5373, Email eyedoc@alaska.netPurpose: The rate of moderate-to-severe hearing loss in Southeast Asia is 5.8%, among the world’s most prevalent. However, it is difficult to measure for people whose healthcare access is limited by the ongoing civil war. Therefore, a cross-sectional study of the impacts of hearing loss was incorporated with ongoing vision/cataract clinics along the Thai-Burma border.Patients and Methods: In this cross-sectional observational study, culturally sensitive informed consent was obtained from patients presenting to a regionally promoted hearing clinic in Karen State, Burma (Myanmar) with a chief complaint of hearing loss. They were then administered a standardized survey derived from the Hearing Handicap Inventory for Adults/Elderly (HHI), then assessed based on history, otoscopy, Weber and Rinne testing, and portable audiometry.Results: Twenty-two adults and children presented with a chief complaint of hearing loss, and 26 others came seeking vision care needing cataract surgery. HHI survey showed 41% had mild-to-moderate, and 34% had moderate-to-severe hearing impairment. On a 0– 4 Likert scale, prominent complaints due to hearing loss were feeling upset (2.4 ± 1.8), limited social life (2.2 ± 1.6), using the phone less (2.1 ± 1.8) and needing to be warned of the danger by others (2.1 ± 1.9). Seventy-three percent had no prior hearing care. Access was limited due to financial (59%), limited travel (50%), and military conflict (41%). Pure-tone averages were 55.3 + 22.1 dB and 67.9 + 14.5 dB for the right and left ears, respectively. Pure tone averages are negatively correlated with HHI survey score (R = − 0.53). Chicken feathers were a common mechanism of ear drum trauma. Twenty patients received Solar Ear hearing aids.Conclusion: Ongoing military conflict in the Karen State leaves the internally displaced people with high prevalence of hearing loss and fear of additional injury due to inability to hear danger. Surveys such as this appear more useful to assess the individual impact of hearing loss rather than severity. Efforts by regional medics to provide hearing care should be supported.Plain Language Summary: Residents in a war zone in Karen State, Burma, had survey, ear exam and audiometry showing high prevalence of hearing loss including tympanic membrane perforation by chicken feathers.Keywords: internally displaced persons, hearing loss, audiometry, chicken feather injury, tympanic membrane perforation, health care access

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]

Objectives: The aim of the current study was to evaluate the efficacy of PRF-augmented fascia tympanoplasty versus cartilage tympanoplasty in repair of large TM perforations. Methods: This randomized clinical trial included 156 patients with dry large tympanic membrane perforations. Patients were randomly allocated into 2 groups, cartilage tympanoplasty group (n = 77) and platelet rich fibrin (PRF) augmented tympanoplasty group (n = 79). Graft take rates, hearing outcomes, operative time, and postoperative complications were documented and compared. Results: Graft take rate was 96.1% in the cartilage group and 93.7% PRF group with no statistically significant difference. Operative time was significantly longer in the cartilage group. No differences in the hearing outcomes and postoperative complications were reported. Conclusion: Application of PRF on the fascia in tympanoplasty promotes healing of the tympanic membrane. PRF is safe, cheap, readily available, and easily prepared and applied. It increases the success rates of large tympanic membrane perforations without the need for cartilage grafts. [ABSTRACT FROM AUTHOR]

Objectives: Eustachian tube dysfunction (ETD) is a common disease associated with chronic otitis media. A standard diagnostic tool for ETD in patients with tympanic membrane perforation is still lacking. We developed and validated a new diagnostic model for ETD in patients with tympanic membrane perforation. Methods: A prospective study was conducted in patients who had tympanic membrane perforation from February to August 2023. We collected clinical characteristics and examination results including otoscopy, nasal endoscopy, tubomanometry, and 5-item Eustachian Tube Score (ETS-5). Univariate and multivariate logistic regression analysis was performed to determine the independent diagnostic factors. Based on this, the nomogram model was constructed. The discrimination and calibration of the nomogram were evaluated using the area under the curve (AUC), the C-index, the calibration curve, and the decision curve analysis (DCA). Results: A total of 40 participants were enrolled in the study. ETS-5 score and Eustachian tube opening mucosa inflammation in the nasopharynx were significant predictors in identifying ETD. Based on the above independent predictors, a diagnostic nomogram was successfully established. The sensitivity and specificity of the diagnostic model were 80.0% and 90.0%, respectively. The AUC and the C-index of the diagnostic model were both 0.901, which suggested that the model had a good discrimination power. The calibration curve indicated a good calibration degree of the model. DCA showed that the proposed model was useful for clinical practice. Conclusion: The nomogram model is effective and reliable in identifying ETD in patients with tympanic membrane perforation. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the outcomes of endoscopic cartilage myringoplasty (ECM) with or without plasma radiofrequency (RF) tuboplasty (PRT) for repairing chronic large perforation with Eustachian tube dysfunction (ETD). Materials and methods: Chronic large perforations with ETD were randomly divided into receiving ECM or ECM plus PRT. During the 24 months follow-up, the Eustachian tube score (ETS), Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7), ET inflammation scale, hearing results, and graft success rate of the patients were analyzed. Results: A total of 61 subjects were included in the study. Difference of ETS was significant before and after surgery in the ECM + PRT group (P <.05) but the ECM group was not (P >.05). Also, significant between-group difference was found regardless of post-24 months ETS and improvement value. Postoperative ETDQ-7 scores were significantly reduced compared with preoperative ETDQ-7 scores in both groups (P <.05), also, significant between-group difference was found regardless of post-24 months ETDQ-7 scores and improvement value. The graft success rate was 86.7% in the ECM group and 96.8% in the ECM + PRT group at postoperative 24 months (P >.05). In addition, although the ECM + PRT group showed a better air-bone gap improvement than the ECM group, the difference was not significant (13.01 ± 2.97 vs 10.92 ± 0.69 dB; P >.05). No PRT procedure-related serious adverse events were reported during the follow-up process. No patients developed atelectasis or otitis media with effusion in either group. Conclusion: ECM combined with low-temperature PRT did not affect the graft success rate but showed a better long-term improvement in ETS and ETDQ-7 than cartilage myringoplasty for the treatment of chronic perforation with ETD. In addition, although PRT showed a better hearing improvement, the difference was not significant between the 2 groups. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to compare the postoperative infection and graft success rates, and the hearing improvement, after endoscopic cartilage underlay myringoplasty with versus without antibiotic ointment coating. Materials and methods: This was a retrospective case-control study. The clinical records of patients who underwent endoscopic cartilage underlay myringoplasty and who met the selection criteria were retrieved and divided based on middle ear packing status into groups with antibiotic ointment packing (AOP group) and with no antibiotic ointment packing (no-AOP group). The operation time, postoperative infection, graft success status, and hearing improvement were compared between the 2 groups. Results: Patients with 166 perforations constituted the AOP group, and patients with 141 perforations comprised the no-AOP group. At 3 months postoperatively, middle ear infections had occurred in 24 (14.5%) ears in the AOP group and 4 (2.8%) ears in the no-AOP group (P <.01). At 12 months postoperatively, the graft success rate was 81.3% in the AOP group and 97.9% in the no-AOP group (P <.01). No significant group differences were observed, preoperatively (P =.657) or postoperatively (P =.578), in the air-bone gap (ABG) values or mean ABG gains (P =.758). Conclusion: Middle ear packing without antibiotic ointment coating does not increase the postoperative infection rate or reduce the graft success rate after endoscopic cartilage underlay myringoplasty compared to antibiotic ointment coating. On the contrary, coating with antibiotic ointment increases the risk of postoperative infection given the complexity of middle ear manipulation. [ABSTRACT FROM AUTHOR]

Chronic tympanic membrane (TM) perforation is a tubotympanic disease caused by either traumatic injury or inflammation. A recent study demonstrated significant progress in promoting the regeneration of chronic TM perforations through the application of nanofibers with radially aligned nanostructures and controlled release of growth factors. However, radially aligned nanostructures with stem cell-stimulating factors have never been used. In this study, insulin-like growth factor binding factor 2 (IGFBP2)-incorporated radially aligned nanofibrous patches (IRA-NFPs) were developed and applied to regenerate chronic TM perforations. The IRA-NFPs were prepared by electrospinning 8 wt% polycaprolactone in trifluoroethanol and acetic acid (9:1). Random nanofibers (RFs) and aligned nanofibers (AFs) were successfully fabricated using a flat plate and a custom-designed circular collector, respectively. The presence of IGFBP2 was confirmed via Fourier transform infrared spectroscopy and the release of IGFBP2 was sustained for up to 20 days. In vitro studies revealed enhanced cellular proliferation and migration on AFs compared to RFs, and the incorporation of IGFBP2 further promoted these effects. Quantitative real-time PCR revealed mRNA downregulation, correlating with accelerated migration and increased cell confluency. In vivo studies showed IGFBP2-loaded RF and AF patches increased regeneration success rates by 1.59-fold and 2.23-fold, respectively, while also reducing healing time by 2.5-fold compared to the control. Furthermore, IGFBP2-incorporated AFs demonstrated superior efficacy in healing larger perforations with enhanced histological similarity to native TMs. This study, combining stem cell stimulating factors and aligned nanostructures, proposes a novel approach potentially replacing conventional surgical methods for chronic TM perforation regeneration. Chronic otitis media (COM) affects approximately 200 million people worldwide due to inflammation, inadequate blood supply, and lack of growth factors. Current surgical treatments have limitations like high costs and anesthetic risks. Recent research explored the use of nanofibers with radially aligned nanostructures and controlled release of growth factors to treat chronic tympanic membrane (TM) perforations. In this study, insulin-like growth factor binding protein 2 (IGFBP2)-incorporated radially aligned nanofibrous patches (IRA-NFPs) were developed and applied to regenerate chronic TM perforations. We assessed their properties and efficacy through in vitro and in vivo studies. IRA-NFPs showed promising healing capabilities with chronic TM perforation models. This innovative approach has the potential to improve COM management, reduce surgery costs, and enhance patient safety. [Display omitted] [ABSTRACT FROM AUTHOR]

Polymer piezoelectrics with high electromechanical energy conversion (HEEC) are very promising for flexible acoustoelectric devices. However, reducing thickness and improving ordered polarization and ferroelectricity while maintaining high mechanical strength pose enormous fabrication challenges for polymer piezoelectric membranes—additionally, noise management in the acoustoelectric conversion remains an open issue. Here, we present a hydro-levitation superspreading approach for fabricating polymer nanomembranes with ordered crystalline phases and sub-nanostructures on the water surface. The elastic piezoelectric nanomembrane (EPN) is only 335 nanometers thick and consists of a conductance-stable piezoelectric layer sandwiched between two elastic damping layers. Such an all-in-one EPN can reduce background noise with low autocorrelation in the environment, suppress spurious noise caused by poor circuit contact, and achieve bandpass filtering of acoustic signals at human voice frequencies. This nanomembrane holds promise in repairing the auditory system of patients with tympanic membrane perforation and in a wide range of other acoustoelectric conversion fields. Creating flexible acoustoelectric devices with ultrathin thickness, high elasticity, stable conductivity, and high electromechanical energy conversion capability poses a challenge. Zhang et al. present a liquid crystal mediated technique that creates an elastic piezoelectric nanomembrane with double noise reduction, offering promise for auditory system reconstruction and other acoustoelectric conversion applications. [ABSTRACT FROM AUTHOR]

Aim: This study is aimed to compare the outcomes of the two techniques (endoscopic single flap tympanoplasty- ESFT versus endoscopic double flap tympanoplasty - EDFT) of endoscopic tympanoplasty for repairing large tympanic membrane (TM)perforations with limited anterior remnant. Methodology: In this randomised controlled trial, forty patients with large sized TM perforations were included and randomised in the ESFT and EDFT arms with twenty patients in each group. Both the groups underwent endoscopic tympanoplasty using temporalis fascia graft. The graft uptake rates and hearing results were compared. Results: Graft success rate was 85% (17/20 cases) in the ESFT group and 90%(18/20 cases) in the EDFT group. The ABG (air-bone gap) improvement median with interquartile range(IQR) was 5 dB (3.12 dB-10 dB) in the ESFT group and 8.75 dB (5dB-11.87 dB) in the EDFT group. The difference was not statistically significant. Conclusions: In our study, there was no statistically significant difference in the graft success rate or hearing gain in ESFT or EDFT group. Moreover, there was longer operative time and need for an extra incision while raising the anterior flap. This lack of statistically significant results in our study may be since the study has a very small sample size. Whether the same conclusion is reproducible needs to be further explored by a larger sized randomised controlled trial. [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]

Objectives: To study the predisposing factors, treatment, and complications of Aspergillus otitis externa. Methods: A retrospective analysis of patients diagnosed with Aspergillus otitis externa at the Department of Otorhinolaryngology, Helsinki University Hospital, between January 2010 and December 2018 was performed. Results: Of the 269 Aspergillus otitis externa (OE) patients, 96 developed otitis media (OM) and 7 developed mastoiditis. Antibiotic and steroid treatment and otological history were risk factors for Aspergillus OE. Systemic diseases and immunocompromising states were more common in mastoiditis patients. Repetitive ear cleaning and topical drugs are primary treatments, but systemic drugs and surgery were needed in resistant and invasive cases. Forty‐five novel tympanic membrane (TM) perforations were reported. A strong association between Aspergillus species and final infection types was found; A. niger was the dominant species in OM and in novel TM perforations, whereas A. flavus and A. fumigatus caused mastoiditis. Some of the TM perforations persisted despite treatment. Permanent hearing impairment was associated with OM and mastoiditis. Conclusion: As Aspergillus OE has the potential to cause acute and chronic complications, fungal OE should be suspected early on if the infection persists after conventional treatment. The identification of Aspergillus species could aid in spotting patients at risk for more severe disease and complications. Intensive local treatment is sufficient in most cases of OE and OM but effective topical antifungals are limited. Patients with Aspergillus OM and mastoiditis should be followed up for hearing impairment and permanent TM perforations after the infection resolves. Level of evidence: Level 4 (The Oxford 2011 Levels of Evidence). Aspergillus otitis externa may lead to a wide range of frequent and rare complications, including tympanic membrane perforations, otitis media, mastoiditis, permanent hearing loss, and cranial nerve palsies. Aspergillus niger causes most otitis media and tympanic membrane perforations, whereas A. flavus, A. fumigatus, and immunocompromising states are predispoding factors for mastoiditis. Careful local treatment is efficient in most cases but surgery and systemic antifungals are needed in profound infections. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to assess the efficacy and safety of ballon dilation of the eustachian tube (BDET) in adult population suffering from Eustachian tube dysfunction (ETD). Methods: Following PRISMA criteria, a systematic review was conducted by searching PubMed, Cochrane, and Embase databases from January 2015 to March 2024. The primary outcomes included Eustachian Tube Score (ETS), tympanometry, and Valsalva maneuver. The quality of studies was assessed using the Quality in Prognostic Studies (QUIPS) instrument. Results: Overall, 11 studies were incorporated into the systematic review: two RCTs, three prospective investigations, and six retrospective studies. The balloon dilation in all investigations was performed using either Spiggle & Theis or Acclarent catheters for balloon dilation. There was heterogeneity across studies examining the effect of BDET on persistent ETD in terms of patient selection, period of follow-up, administration of conservative or surgical therapies, and use of assessment methods. Overall, the treatment yielded alleviation of symptoms, which either exhibited stability over time or demonstrated further improvement after an average duration of follow-up. Moreover, the incidence of complications was categorized as low and resolving spontaneously. The majority of the studies exhibited a high risk of bias related to confounding variables, and consequently, the overall risk of bias across most studies was considered high. Conclusion: The findings suggest BDET holds promise for ETD treatment, reducing symptom severity with minimal complications. Nonetheless, there is a need for improved studies that adhere to established indications, methodologies, and outcomes to establish a more robust body of evidence. [ABSTRACT FROM AUTHOR]

The study was carried out on 50 patients with central perforation in tympanic membrane (dry & inactive stage). The study was done in the department of ENT, MIMS medical college, Nellimarla, Vizianagaram over a period of one year. The study was done on comparison between tympanoplasty procedure using temporalis fascia as graft versus cartilage composite graft. Precise history was taken from respective patients in detail and were examined clinically. Patients with dry perforation with good cochlear reserve, intact and mobile ossicular chain, functioning Eustachian tube were selected randomly for the operation. Tympanoplasty procedure using temporalis fascia as graft was done in 50% (n=25) patients and tympanoplasty procedure using cartilage composite graft was done in 50% (n=25) patients. In this study the age range of patients were from 13 to 50 years, the mean age was 26.62 years, the number of male and female was equal. Right sided disease was predominant in our study and the mean duration of symptom was 11.24 months. The mean pre-operative hearing loss (pure tone average by pure tone audiometry) was 37.84±4.65 dB and mean pre-operative airbone gap was 22.84±4.65 dB. Post-operative Mean air conduction was 23.48±5.54 dB among them 24.2 ±6.26 dB in the fascial group and 22.76±4.73 dB in the cartilage group. This result is not statistically significant. Post-operative mean air-bone gap was 13.84±5.94 dB among them 14.76±5.6 dB in fascial group and 12.92 ±6.23 dB in the cartilage group which is not significant stastistically. Successful graft take-up rate of 88.00% (n=44). The overall success rate among tympanoplasty using temporalis fascia graft(GROUP A) and tympanoplasty using composite cartilage graft (GROUP B) technique were 84.00% (n=21) and 92.00% (n=23) respectively. 12.00% (n=6) patients were marked as failure cases during postoperative follow up period. The overall failure rate among tympanoplasty using temporalis fascia graft (GROUPA) and tympanoplasty using composite cartilage graft (GROUP B) technique were 16.00% (n=4) and 8.00% (n=2) respectively. So the distribution of surgical outcome in terms of success rate or failure rate was statistically insignificant in the two study groups (p=0.384). So the distribution of surgical outcome in terms of success rate or failure rate cartilage composite graft gives a definitely better result than temporalis fascia graft. However, the two method did not differ significantly in terms of hearing improvement. [ABSTRACT FROM AUTHOR]

Children in foster care have complexity around medical decision-making because of their unique custody status. When medical decision-making is necessary for a child in foster care, what perspectives are important? What if opinions are not aligned? Who makes the final decision for consent? This Ethics Rounds focuses on a young child in foster care who has had repeated ear infections. Foster caregivers and family of origin are not in agreement on the treatment plan. Two experts, a foster care pediatrician and a child welfare professional, comment on the important considerations for the case, including involvement of legal representation and best interest representation in medical decision-making as well as the variability in child welfare response by state. [ABSTRACT FROM AUTHOR]

Tympanic membrane (TM) perforation is a serious ear discomfort that can cause hearing loss and make the middle ear vulnerable to infections. In this study, a unique TM patch is designed to mimic the structure of the natural eardrum for tissue engineering of TM perforations. Gelatin methacryloyl (GelMA)‐based TM patches are equipped with microneedles (MNs) to better adhere to the perforation site and developed using the digital light processing (DLP) based 3D printing technique. To impart biofunctionality to the 3D‐printed patches, their surfaces are coated with gentamicin (GEN) loaded poly(vinyl alcohol) (PVA) nanoparticles (NPs) using the Electrohydrodynamic Atomization (EHDA) method. The physicochemical characteristics, drug release behaviour, antimicrobial properties and biocompatibility of GelMA, PVA NP‐coated GelMA, and GEN@PVA NP‐coated GelMA patches are investigated. Morphological analyses confirmed that 3D‐printed GelMA patches are fabricated in desired sizes and geometries and successfully coated with NPs. In vitro antibacterial tests revealed that GEN@PVA NP‐coated GelMA patches have antibacterial activities against Staphylococcus aureus and Escherichia coli. Moreover, in vitro cell culture studies indicated that all GelMA‐based patches have no cytotoxic effect on L929 mouse fibroblast cells. Considering all, these specially designed biofunctional 3D‐printed GelMA patches can be an effective therapeutic approach for repairing TM perforations. [ABSTRACT FROM AUTHOR]

Background: The traditional approach for viewing middle ear structures during ear surgery is still the microscope, which provides both hands' flexibility and binocular vision. The requirement for a clear, direct vision of the working zone is its primary disadvantage. The procedure was modified for the microscope by using an end-aural approach, drilling the bone canal, and then moving the patient and surgeon. However, the microscope has successfully demonstrated that it is the preferred tool for stapedectomy. Objective: To compare endoscopic and microscopic interventions in stapes surgery regarding intraoperative and postoperative outcomes. Patients and methods: The review was a meta-analytic and systematic review that included randomized controlled trials (RCT), case series, and retrospective studies which studied the comparison of microscopic and endoscopic stapes surgery; 15 articles published between 2014 and 2020 were included in our study. Data sources: PubMed, Embase, and Cochrane Library were searched for studies published up to 2020. The inclusion criteria comprised randomized controlled trials, cohort studies, and case–control studies comparing microscopic and endoscopic stapes surgeries. Results: Our results showed that the injury to the chorda tympani nerve was significantly higher in the microscopic group versus the endoscopic group. And also, as regards the operative times, it was significantly longer in the microscopic group versus the endoscopic group. But there is no significant difference as regards pain, dizziness, perforation of the tympanic membrane, delayed conductive hearing and postoperative air–bone gap improvement, and taste disturbance between both groups. Conclusion: Technologically, safely, and promisingly, endoscopic stapes procedures are possible. All things considered, our research shows that both microscopic and endoscopic stapes surgery yields good audiological outcomes. A little amount of data, however, points to a decreased likelihood of chorda tympani injury and taste disturbance when using an endoscope. With comparable side effects to microscopic stapes surgery (pain, tympanic membrane perforation, taste disturbance, dizziness, and delayed conductive hearing), endoscopic stapes surgery seems like a feasible substitute. Endoscopic stapes surgery was found to need shorter operating times. In comparison to endoscopic groups, the postoperative air–bone gap increased considerably in the microscopic group. All of the studies consistently indicated better sight with the endoscope. This meta-analysis of the available data bolsters the application of endoscopic methods in stapes surgery. [ABSTRACT FROM AUTHOR]

Objective: To investigate alterations in middle-ear mechanics after type 1 cartilage tympanoplasty by comparing the ambient pressure absorbance values of the perforated tympanic membrane, normal tympanic membrane and cartilage-grafted tympanic membrane. Methods: Twenty patients diagnosed with non-suppurative chronic otitis media and 20 healthy controls were included. Pure tone audiometry and wideband tympanometry were performed once in the healthy controls and pre-operatively, one month and three months post-operatively in the patients. Results: Using wideband tympanometry, the patients' three-month post-operative ambient pressure absorbance values were found to be similar to those of the healthy controls at low frequencies, while lower ambient pressure absorbance values were recorded at middle and high frequencies. Air–bone gap and ambient pressure absorbance values showed significant negative correlations at 1000 and 4000 Hz both pre- and post-operatively. Conclusion: Generally, the patients' ambient pressure absorbance values were significantly lower at middle and high frequencies than those of the healthy controls. Post-operative wideband tympanometry is a practical tool for investigating the effects of a repaired tympanic membrane on middle-ear dynamics. [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]

Benign dendritic melanocytic proliferation is usually observed in the skin. We report an extremely rare case of a melanocytic lesion in the middle ear mucosa. Only 3 cases of melanocytic lesions in the middle ear have been reported. Our report is the only one that describes an adult with a melanocytic lesion in the middle ear that extended to the inner ear and nasopharyngeal mucosa. A 23-year-old female presented with profound sensory neural hearing loss and recurrent discharge from the right ear. Examination revealed a blue right tympanic membrane with a small perforation. Computed tomography scans and magnetic resonance imaging were performed. After surgical exploration and histopathological examination, the patient was found to have a benign melanocytic lesion in the right middle ear. Melanocytic lesions are commonly found in the skin. There are no previous reports have described adult patients with melanocytic lesions in the middle ear that extend to the inner ear and nasopharynx, which cause profound hearing loss with recurrent ear discharge. These patients require regular follow-up to assess the progression of the lesion and to watch for any malignant behavior. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the impact of central and marginal tympanic membrane perforations (TMP) on wideband absorbance (WBA) and compare it with normal ears. Material and methods: Three groups of individuals, aged 18 to 50 years: Group I with central TMP (n = 65), Group II with marginal TMP (n = 13), and Group III with normal middle ears (n = 20) were considered. WBA measurements were performed at peak and ambient pressure conditions across frequencies. Results: Significant differences in WBA were observed between the groups with central and marginal TMP and the normal ear group across all frequencies. Central TMP exhibited decreased absorbance at low frequencies and increased absorbance at high frequencies, peaking at 5000 Hz. Marginal TMP showed peaks at 600, 4000, and 6000 Hz with decreased absorbance at 2000 Hz. Central TMP exhibited lower absorbance than marginal TMP at lower frequencies, while marginal TMP showed decreased absorbance at mid and high frequencies. Conclusions: These findings highlight the role of WBA in differentiating normal ears from those with TMP. Understanding TM vibration patterns and frequency-dependent variations in absorbance enhances diagnostic accuracy and clinical management. [ABSTRACT FROM AUTHOR]