Introduction  The use of endoscope is rapidly increasing in otological and neuro-otological surgery in the last 2 decades. Middle ear surgeries, including tympanoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Superior visualization and transcanal access to diseases normally managed with a transmastoid approach are touted as advantages with the endoscope. Objectives  The present study aimed to compare the outcomes of endoscopic and microscopic cartilage tympanoplasty (Type I) Methods  This was a retrospective comparative study of 70 patients (25 males and 45 females) who underwent type I tympanoplasty between March 2015 and April 2016. The subjects were classified into 2 groups: endoscopic tympanoplasty (ET, n  = 35), and microscopic tympanoplasty (MT, n  = 35). Tragal cartilage was used as a graft and technique used was cartilage shield tympanoplasty in both groups. Demographic data, perforation size of the tympanic membrane at the preoperative state, operation time, hearing outcome, and graft success rate were evaluated. Results  The epidemiological profiles, the preoperative hearing status, and the perforation size were similar in both groups. The mean operation time of the MT group (52.63 ± 8.68 minutes) was longer than that of the ET group (48.20 ± 10.37 minutes), but the difference was not statistically significant. The graft success rates 12 weeks postoperatively were 91.42% both in the ET and MT groups, that is, 32/35; and these values were not statistically significantly different. There was a statistically significant improvement in hearing within the groups, both pre- and postoperatively, but there was no difference between the groups. Conclusion  Endoscopic tympanoplasty is a minimally invasive surgery with similar graft success rate, comparable hearing outcomes and shorter operative time period as compared to microscopic use.

No abstract

Background: It is important to study the epidemiologic features and predisposing factors of corneal ulcer and subsequently to find out its causative agents and their antimicrobial susceptibility patterns in a given community, climate and culture. Aims & Objectives: This prospective study of 100 cases of corneal ulcer was undertaken to bring out the bacterial and fungal prevalence among different age groups. Materials and Methods: Corneal scrapings were collected from all patients. One corneal swab and three corneal scrapings were collected. Direct examination of samples was done by potassium hydroxide wet mount and gram stained smear and then inoculated onto blood agar, MacConkey's agar and Saboraud's dextrose agar media. Identification of fungal growth finally was done based on its macroscopic and microscopic features. Bacterial colonies were identified by Gram staining and standard biochemical tests and antimicrobial susceptibility testing was carried out for each bacterial isolate. Results: Out of total 100 specimens of corneal ulcer, only 55% cases were found to be culture positive in which bacteria were more frequently isolated than fungi. Staphylococcus aureus and Aspergillus spp were the most frequent bacterium and fungus. The incidence was higher in males and in age group of >40-60 years. While S. aureus was found to be most sensitive to vancomycin, Staphylococcus epidermis was most sensitive to cefazoline. Conclusion: S. aureus and Aspergillus spp were the most common isolate to be associated with corneal ulcer, and the incidence was higher in rural population, especially farmers, who were constantly exposed to vegetative matter.

Objectives: To investigate the outcomes of graft uptake and hearing results in the repair of anterior perforation via a total endoscopic transcanal approach using a single or double perichondrium reinforced cartilage underlay technique. Study Design: Retrospective study. Setting: Tertiary referral hospital. Materials and Methods: We analyzed 65 patients who underwent surgery for anterior perforation. All surgeries were done via an endoscopic transcanal approach using tragal cartilage as graft, underlay technique reinforced with single or double perichondrium. Two groups were created in which group A had single perichondrium reinforcement and group B had double perichondrium. Graft uptake and hearing outcomes were evaluated between the two groups. Results: During the study period, 65 patients were included, of which 3 were lost to follow-up, and thus, only 62 patients were assessed. As for the surgical outcome, graft uptake was observed in 95.2% (n = 59) of patients, 6 months after the intervention. Graft uptake was not statistically significantly different between groups A and B and was 95% in both. There was a statistically significant improvement in hearing across the series overall, with no significant differences seen between group A and group B. Conclusions: The endoscopic approach for myringoplasty offers superior visualization, especially for anterior perforation avoiding postaural approach and canaloplasty. Endoscopic single or double perichondrium reinforced cartilage underlay technique is a reliable method for repair of anterior perforation. There is no difference in using single or double perichondrium reinforcement. Thus, we recommend using single or double perichondrium reinforcement depending on the need during the surgery.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Objective To compare the rate of graft uptake and postoperative hearing outcomes of Type I tympanoplasty with perichondrium reinforced cartilage palisade to temporalis fascia for large tympanic membrane (TM) perforations over 5 years follow-up period. Materials and methods This was a retrospective comparative study involving patients with chronic otitis media with large TM perforations. The patients underwent type I tympanoplasty using either perichondrium reinforced cartilage palisade (CP group) or temporalis fascia (TF group) as the graft via a transmeatal approach and under local anesthesia. Morphological and functional results were recorded at three- and five years follow-up. Demographic profiles including age and sex, surgery side, contralateral disease and graft uptake rate, as well as hearing outcomes, were compared between the two groups. Results At three years follow-up, graft uptake was 94.87% for perichondrium reinforced cartilage palisade and 80.7% for fascia, respectively, (p = 0.67). At five years follow-up, the uptake rate dropped to 87.17% in the CP group, but to 66.6% in the TF group (p=0.019). Hearing improved after surgery in both groups, and showed no significant difference between the two groups. Conclusion Over long-term, perichondrium reinforced palisade showed a statistically significant better outcome regarding graft uptake than temporalis fascia in type Itympanoplasty for large TM perforations with comparable audiometric results

Introduction  Middle ear surgeries, including myringoplasty, have increasingly utilized endoscopes as an adjunct to or as a replacement for the operative microscope. Objectives  The objective of the present study was to evaluate the graft uptake rate and to evaluate the hearing results. Methods  This is a prospective study. We have analyzed 139 patients who underwent surgery for chronic otitis media (COM) of the mucosal type. All of the surgeries were performed exclusively under total endoscopic transcanal approach using tragal cartilage as graft, underlay technique. We have evaluated the postoperative graft uptake and performed a hearing evaluation at 6 weeks, at 12 weeks, and at 6 months. Results  During the study period, 139 patients were included, out of which 13 were lost to follow-up; therefore, only 126 patients were assessed. All of the cases were performed under total endoscopic approach. As for the surgical outcome at the postoperative otoscopy, 3 cases had initial uptake at 3 months and failed later; therefore, complete closure of the perforation was observed in 97.6% ( n  = 123) of the patients 6 months after the intervention. Four patients presented with preoperative anacusis; therefore, only 122 patients were included for hearing evaluation. The preoperative air conduction threshold (ACT) and airbone gap (ABG) were 43.34 ± 11.53 and 24.73 ± 7.89, respectively. Postoperatively, the ACT and ABG closure were 28.73 ± 15.75 and 11.91 ± 8.41, respectively. This difference was statistically significant ( p  < 0.001). Conclusion  The endoscopic approach for myringoplasty offers excellent visualization; avoids postaural approach, enables a faster recovery, requires less hospital stay, with excellent graft closure rate and improved functional outcomes.

Introduction: To evaluate the corneal astigmatism and contrast sensitivity before and after pterygium surgery and to study the relationship between amount of astigmatism and contrast sensitivity in various grades of pterygia. Material and Method: Sixty three eyes of 63 patients with primary pterygia were studied before and after surgery. The astigmatism induced by primary pterygium was measured by manual keratometer and contrast sensitivity by Pelli Robson chart. Preoperative and postoperative values were compared using paired t-test and ANOVA test. Result: Astigmatism decreased significantly following pterygium excision. The mean preoperative refractive cylinder decreased from 3.29±1.46 D to 1.49±0.82 D postoperatively. Surgical removal of pterygium caused a significant reduction in refractive astigmatism. The amount of astigmatism decreased significantly following pterygium excision in grade II , grade III and in grade IV. In grade I pterygium, decrease in the amount of astigmatism was not statistically significant (p=0.515). The contrast sensitivity increased significantly following pterygium excision. The mean preoperative contrast sensitivity increased from 1.49±0.21 to 1.70±0.20 postoperatively. Surgical removal of pterygium caused a significant improvement in contrast sensitivity. Conclusions: Surgical excision of pterygium improves contrast sensitivity, visual acuity and reduces astigmatism. Contrast sensitivity testing may provide additional objective methods for documenting impaired vision in patients with pterygium when Snellen visual acuity is minimally affected. Corneal astigmatism and contrast sensitivity values in patients with pterygia are useful indicators for the need of pterygium surgery or as indicators of surgical success.