Cartilage shield tympanoplasty (CST) is an acknowledged procedure to repair total tympanic membrane perforations. The main objective of this study was to share our experience of CST, in form of its technique, graft uptake and hearing outcomes.

Retrospective chart review.

Tertiary care hospital, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.

A total of 69 cases of type 1 CST, from January 2013 to March 2014. We followed all patients for a minimum period of 6 months.

Therapeutic.

Graft uptake rate, along with preand postoperative pure tone audiogram air bone gap (ABG) and postoperative complications, was evaluated. We compared ABG using Student's t-test.

Graft uptake was seen in 68 cases (98.5%). The mean pre- and postoperative pure tone audiometry (PTA)-ABG was 37.58 ± 6.43 dB and 20.19 ± 8.14 dB, respectively. Hearing improvement was maximum at 2 kHz with mean postoperative value of 17.73 dB, and the least improvement was seen at 8 kHz with value of 30 dB in postoperative period.

The graft uptake rate was excellent, and hearing results were satisfactory. Cartilage shield tympanoplasty should be a recommended procedure for total perforation, subtotal perforation and revision cases. However, long-term results are still awaited.

Patadia S, Keshri A, Shah S. Cartilage Shield Tympanoplasty: A Retrospective Chart Review of 69 Cases. Int J Otorhinolaryngol Clin 2015;7(3):105-108.

To evaluate the anatomical and audiological outcomes of synchronous ossiculoplasty with ossicular replacement prosthesis during canal wall down mastoidectomy for advanced cholesteatoma.

The prospective study was done at a tertiary referral institute included 30 patients of cholesteatoma who underwent canal wall down mastoidectomy. Ossicular reconstruction was performed using polytetrafluoroethylene (PTFE) (teflon) partial or total ossicular replacement prosthesis. Patients were assessed at 1st, 3rd and 6th postoperative months for graft uptake and hearing evaluation using pure tone audiometry (PTA) in which air bone gap (ABG) closure and mean ABG was calculated and compared with the mean preoperative ABG.

The mean ABG [both total occicular replacement prosthesis (TORP) and partial occicular replacement prosthesis (PORP) groups combined] considerably reduced from 34.33 ± 4.10 dB preoperatively to 15.47 ± 7.65 dB postoperatively at 6 months. There was a 46.29% of closure of ABG in 1st month, which closed more (53.89%) in 3rd month and even more (55.34%) in 6th postoperative month. p < 0.001 showed the ABG closure ratio and reduction in the mean ABG was statistically significant in the postoperative period.

Ossicular reconstruction with ossicular replacement prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure.

Shareef M, Motwani G, Verma D, Malik NUD, Choudhary SR. Synchronous Ossiculoplasty with Ossicular Replacement Prosthesis during Canal Wall Down Mastoidectomy for Advanced Cholesteatoma: Anatomical and Audiological Outcomes. Int J Otorhinolaryngol Clin 2015;7(3):109-113.

To compare the outcome of conservative management vs surgical intervention (realignment of torn edges) in traumatic perforations of the tympanic membrane (TM).

Cohort study, Interventional, Observational, Prospective.

Karnataka Institute of Medical Sciences, Hubli, Karnataka.

All patients attending the Department of Otolaryngology with otological injuries.

Patients with isolated traumatic tympanic membrane perforations without evidence of temporal bone fractures were managed either conservatively or surgically by realigning the torn edges of perforation under local anesthesia and supporting with gelfoam.

Healing of perforation, duration taken for complete healing and hearing outcome by pure tone audiometry.

Perforations in patients taken up for surgical intervention healed faster. Though the difference in outcome, i.e. healed TM perforation between the 2 groups was not statistically significant, the difference in duration taken for healing was observed to be statistically significant (p < 0.05).

Minimal surgical intervention involving realignment of torn edges of perforation and supporting with gelfoam enables faster healing.

Saimanohar S, Gadag RP, Subramaniam V. Management of Traumatic Perforations of the Tympanic Membrane: A Clinical Study. Int J Otorhinolaryngol Clin 2015;7(3):114-116.

To evaluate the anatomical (an intact tympanic membrane without atelectasis or lateralization) and audiological outcomes of type 1 cartilage palisade tympanoplasty.

The prospective study was done at a tertiary referral institute included 30 patients with mucosal type chronic otitis media requiring type 1 tympanoplasty including subtotal or total perforations and revision cases. The tympanic membrane reconstruction was done using full thickness broad cartilage palisades harvested from the tragus or concha with attached perichondrium laterally. Patients were assessed at 1st, 3rd and 6th postoperative months for assessment of graft uptake, healing of tympanic membrane and hearing evaluation using pure tone audiometry.

Total 27 out of 30 patients had fully epithelized completely healed grafts postoperatively at 1 month (success rate of 90%) while three patients had small defect. One out of these three patients showed complete healing of graft while remaining two had persistent defect at 3rd and 6th months postoperatively. The mean pure tone air bone gap considerably reduced from 33.27 ± 4.29 dB preoperatively to 12.67 ± 5.68 dB postoperatively at 6 months.

Tympanic membrane reconstruction using full thickness palisades of cartilage provides good anatomical and audiological results with significant improvement of hearing specially in cases of subtotal or total perforations, revision surgery, atelectasis and Eustachian tube disorders where healing of tympanic membrane has much poorer prognosis irrespective of the surgical technique used.

Gupta S, Lade H, Verma D, Malik NUD. Cartilage Palisade Type 1 Tympanoplasty: Anatomical and Audiological Outcomes. Int J Otorhinolaryngol Clin 2015;7(3):117-120.

To evaluate the predictability of aditus patency in mucosal chronic otitis media (COM) with sclerosed mastoid using clinical and radiological tests.

Prospective study.

Thirty-five cases of mucosal COM with sclerosed mastoid were taken for antrotomy with tympanoplasty. The preoperative evaluation of aditus patency was done using clinical examination, inflation deflation test for Eustachian tube function and high-resolution computed tomography (HRCT) temporal bone. The intraoperative patency was tested by water test.

This study shows that there is statistically insignificant correlation between duration of discharge, tympanosclerosis and Eustachian tube function with aditus patency. There is statistically significant relationship between HRCT temporal bone and aditus patency (p < 0.0001).

High-resolution computed tomography temporal bone is a reliable predictor for aditus patency and we recommend routine use in sclerosed mastoid before all tympanoplasties for best results.

Varma A, Maithani T, Agrahari AK, Pandey AK, Singh VP. Clinical and Radiological Predictability of Aditus Patency in Mucosal COM with Sclerosed Mastoid: An Analytical Study. Int J Otorhinolaryngol Clin 2015;7(3):121-124.

Is there any advantages of using methylene blue in myringoplasty? To compare the results of methylene blue stained temporalis fascia graft with unstained temporalis fascia graft in underlay myringoplasty.

In this prospective study, 120 patients of either sex in age group of 15 to 50 years with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited. Patients were initially managed medically to make the ear dry and after that they were operated upon. Sixty patients underwent underlay myringoplasty using methylene blue stained temporalis fascia graft and 60 patients underwent underlay myringoplasty using unstained temporalis fascia graft. Follow-up period was at least 6 months.

Graft uptake and hearing improvement was comparable in both groups. Although there was 10% higher graft uptake using methylene blue stained temporalis fascia (95%) as compared to unstained temporalis fascia graft (85%), however the difference was not statistically significant (p = 0.5). But there was statistically significant difference in gain in hearing threshold (gain in air-bone gap) in the myringoplasty using methylene blue stained temporalis fascia graft (18 dB ± 7.156) as compared to myringoplasty using unstained temporalis fascia graft (13.7 dB ± 5.70814) (p = 0.04).

Methylene blue use in myringoplasty allows improved identification of the graft, can be very helpful for trainee residents and reduce the time of a graft placement. Also, methylene blue as an antioxidant and antimicrobial properties, prevents degradation and lysis of fascia graft, improves the overall success rate of graft uptake with no adverse effects.

Kathuria B, Dhingra H, Gulia J, Kakkar V, Yadav SPS, Hernot S, Bishnoi S. Staining in Tympanoplasty: Is Methylene Blue Rational? Int J Otorhinolaryngol Clin 2015;7(3):125-131.

To evaluate the efficacy of endoscopic myringoplasty and comparison with conventional myringoplasty.

Sixty cases of clinically diagnosed chronic suppurative otitis media with dry central perforation were taken into account of which 30 cases were undergone endoscopic myringoplasty and 30 cases undergone conventional myringoplasty. All patients were followed up on 3rd, 7th, 15th day, 6th weeks, 3rd and 6th months after surgery.

The tympanic membrane's perforation healing rate was 86% (26/30), in conventional group of myringoplasty and 83% (25/30) in endoscopic group of myringoplasty and average hearing gain in conventional group was 13.96 dB and in endoscopic group was 15.03 dB.

The surgical outcome of endoscope assisted myringoplasty in terms of graft uptake and hearing improvement was comparable to the conventional microscope assisted myringoplasty, but in terms of cosmesis and postoperative recovery patients in the endoscope group had better results.

Kumar M, Kanaujia SK, Singh A. A Comparative Study of Endoscopic Myringoplasty vs Conventional Myringoplasty. Int J Otorhinolaryngol Clin 2015;7(3): 132-137.

To address the fat grafting to tympanic membrane perforations—fat myringoplasty type I—and its impact over the hearing mechanism of the middle ear for both small (< 25% of the tympanic membrane) and large perforation (> 75 % of the TM).

Al-qahtani B, Al Tuwaijri M, Al Mokhatrish M. Fat Myringoplasty and its Impact on the Hearing Mechanism of Middle Ear. Int J Otorhinolaryngol Clin 2015;7(3):138-140.

Verma H, Dass A, Singhal SK, Gupta N. Late Presentation of Idiopathic Tympanic Membrane Ossification with External Auditory Canal Stenosis. Int J Otorhinolaryngol Clin 2015;7(3):141-143.

John BT, Augustine AM, Lepcha A, Mathew J, Moses V. Bleeding Mass in the Ear: A Rare Etiology. Int J Otorhinolaryngol Clin 2015;7(3):144-146.

Kumar D, Somavanshi S, Kumar H, Agrawal A, Singh H. Schwannoma of the External Auditory Canal: A Rare Location. Int J Otorhinolaryngol Clin 2015;7(3):147-148.