INTRODUCTIONThere is high incidence of conductive hearing loss caused by perforations of tympanic membrane in chronic otitis media. The results of studies regarding the effect of the size and the site of perforations on the degree of hearing loss conflicting.Some studies show a correlation between degree of hearing loss and the size of tympanic membrane perforation that larger perforation causes larger hearing loss.1-4 The weak point of these studies is the crude estimation of the size of tympanic membrane perforation. In our study, we use a program enable us to calculate the surface area of perforation precisely and designing a logarithmic equation between degree of hearing loss and surface area of perforation.The results of articles were conflicting about the effect of perforation site on the degree of hearing loss. The present studies depend on comparing the mean of the degree of hearing loss of different site of perforation ABSTRACT Background: Study performed to evaluate relationship between surface area of tympanic membrane perforation and degree of hearing loss and the effect of perforation site on that relationship in patients with chronic otitis media. Methods: Seventy-five perforated tympanic membranes from 63 patients aged between 14-45 years with inactive mucosal chronic otitis media included in this study. Rigid endoscope (0 degree) used to take an image for each perforation that analyzed by Autodesk Design Review 2013 program. Degree of hearing loss assessed by pure tone audiometry. Surface area of perforation classified into four groups according to its percentage. Perforation site categorized into three groups regarding its relation to handle of malleus. Data analysis carried out with SPSS program version 17. Results: We studied 34 females and 29 males with different surface area and site of perforations. It observed that with increment of surface area of tympanic membrane perforation, the degree of conductive hearing loss increases (P value=0.000). This relationship expressed in a logarithmic equation. The mean hearing loss of posterior perforation was 1.7±0.5 dB for each 1% of perforation but in anterior perforation was 1.5±0.6 dB for each 1% of perforation (p value 0.185). Conclusions: In chronic otitis media, there is a quantitative logarithmic relationship between surface area of tympanic membrane perforation and degree of conductive hearing loss. The site of perforation does not play a significant role in determining degree of conductive hearing loss.

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Chronic Otitis Media (COM) is a long standing inflammation of the middle ear and mastoid, it is a common health problem. The evidence of microbiology in COM in different studies showed variable frequencies, but little studies showed the role of fungal colonization. This study aimed to identify the microbiology of cholesteatomatous COM concentrating on clarification of fungal colonization. A prospective study was done in otolaryngology department of Basrah Teaching Hospital from June 2018 till July 2019. This study was carried on a randomly collected data of 25 patients diagnosed as COM by a specific designed questionnaire including history and examination. The specimen was collected during mastoid surgery which included any cholesteatoma in the middle ear and mastoid and sent for bacteriological and mycological examination. Statistical study was done by using SPSS v.23 Bacteria were isolated in 84% of the cases in which Pseudomonas aeruginosa was the commonest one (33.3%). Fungi were isolated in 28% cases, in which the Aspergillosis was the commonest (19.3%). There is no recognizable pattern of significant association between the fungi and the reported complications or the stage of the disease. In conclusion, there is significant percentage of fungal colonization in COM with cholesteatoma so it may has a role in inflammatory response of perimatrix, but there is no clear mechanism of this interaction, so may need larger sample and longer duration of study with postoperative follow-up and trail of combined antibiotic-antimycotic treatment.

Temporal bone can be affected by different conditions. In our area, the most common disease conditions of the temporal bone are fibrous dysplasia, histiocytosis X and squamous cell carcinoma. This is a report of three females who have temporal bone disease conditions. They have poor clinical symptomatology. Since the incidence of malignancy is rare so differentiation between chronic inflammation and tumors is difficult and a biopsy is a must. Computed tomography (CT) was the diagnostic aid of choice which also was very helpful for follow-up to assess the disease progression, while Magnetic resonance imaging (MRI) was useful to identify intracranial extension. Treatment of these conditions included surgery, radiotherapy and chemotherapy.

Nasal packing is carried out in many nasal surgeries specially in septoplasty for hemostasis and internal stabilization of the cartilaginous & bony skeleton of the nose. However, these packing methods are not a harmless procedures and for this reason their benefit has been tested. The study was performed to compare the use of plastic intranasal splints with or without anterior nasal packing to determine the need of nasal packing after septoplasty. This is a prospective comparative study which was carried out in Basrah General Hospital, Otolaryngology Department, Basrah, Iraq in the period from July 2014 to April 2015. Forty seven patients of different age and gender groups were included in the study. Analysis was done regarding their history and examination including nasendoscopy which was done before septoplasty. The patients were randomly selected at the end of the procedure into two groups; one had plastic intranasal splints without anterior packing and the other had plastic intranasal splints with two different types of packing materials (ribbon gauze impregnated with Vaseline and glove fingers). Patients were compared for postoperative pain, headache, discomfort, bleeding, sleep difficulty, epiphora, septal hematoma on the day of the operation, 24 hours and 48 hours postoperatively. The collected data was analyzed by using SPSS v.17. The age of patients in this study ranged from 18 to 44 years with mean age of (29.6±6.2) years and most of them were between 28 to 37 years (48.9%). Among those 47 patients, 28 (59.6%) were males and 19 (40.4%) were females with male:female ratio was 1.47:1. Pain, headache, discomfort and bleeding was higher in patients in group two with anterior nasal packing materials especially during removal of the packing. there was significant reduction in the frequency of sleep disturbance, epiphora among the patients in group one without nasal packing, however there was no significant difference in septal hematoma between two groups. In conclusion, the plastic intranasal splints can be used alone without the need of anterior nasal packing materials after septoplasty as it can be considered as a type of packing methods that offers the advantages of elimination of pain and discomfort and reduce the complications of packing. The anterior nasal packing should be reserved only for selected cases.