Chronic Otitis Media (COM) is a major cause of acquired hearing impairment especially in developing countries. Persistent perforations occur either due to improper treatment of recurrent otitis media or infected traumatic perforation. Myringoplasty, repair of the Tympanic membrane using autologous temporalis fascia, is the standard procedure for COM. Other graft materials commonly used include tragal perichondrium, tragal cartilage and adipose tissue. This prospective study aims to compare the surgical and audiological outcome of fat plug myringoplasty [FPM] and conventional myringoplasty using temporalis fascia [CM-TF] in COM with small dry central perforation. A total of 60 patients of COM with small dry central perforation, aged 16-60 years, during the study period of October 2013 to August 2015 were divided into two groups of 30 cases each. The first group underwent FPM while the second group underwent CM-TF. The graft uptake and hearing outcome [pre operative and 3 months post operative PTA] were assessed. The surgical outcome of FPM with graft uptake of 86.7% was comparable to CM-TF with a graft uptake of 90%. The mean post operative hearing gain in FPM was 3.43 ± 2.81 dB which correlated well with that of CM-TF with 3.85 ± 3.05 dB. The duration of hospital stay and operative time was significantly lower in FPM group. FPM can be safely performed in cases with dry, small central perforations of the tympanic membrane with outcomes comparable to CM-TF.
Background: Mucormycosis is an opportunistic, potentially lethal, fungal infection predisposed by uncontrolled diabetes mellitus, immunosuppressive therapy, primary or secondary immunodeficiency, injudicious use of corticosteroids, hematological malignancies, hematological stem cell transplantation, solid organ malignancies, solid organ transplantation. Rhino-orbital mucormycosis is the commonest form of mucormycosis. This study was done to discuss the management strategies (orbital decompression/clearance, orbital exenteration, retrobulbar amphotericin B) in the treatment of orbital mucormycosis and its clinical outcomes. Methods: A retrospective descriptive study was conducted between May 2021 and October 2021 at Bowring and Lady Curzon hospital, Shri Atal Bihari Vajpayee Medical College and Research Institute, Karnataka, India. 181 patients with post-COVID RTPCR negative rhino-orbital mucormycosis were included in the study. Patients underwent endoscopic orbital clearance, orbital exenteration based on the extent of orbital involvement. Results: 143 were males and 38 were females. 160 patients underwent orbital decompression and clearance of necrotic tissue. 21 patients underwent orbital exenteration. Final visual acuity of perception of light (PL) positive and above was achieved in 147 patients. 57/58 (98.27%) patients had improvement in extraocular movements post-surgery and resolution of diplopia after orbital decompression/clearance. Conclusions: Endoscopic orbital clearance helps to reduce the need for orbital exenteration in PL negative patients. TRAmB as adjuvant helps in decreasing the ocular morbidity. Orbital exenteration is best avoided, when possible, to avoid cosmetic disfigurement and psychological trauma to the patient.
Background: Tympanosclerosis is an irreversible, though not immutable, end result of any unresolved specific or nonspecific inflammatory disease of middle ear characterized by anatomical distortion resulting in functional impairment. The objective of the study was to assess hearing in patients with tympanosclerosis with intact tympanic membrane (TM) and to correlate degree of hearing loss with respect to site of tympanosclerotic patch on TM. . Thirty patients enrolled for study were subjected to otoendoscopy, pure tone audiometry and tympanometry. Site of tympanosclerotic patch on tympanic membrane and hearing loss were assessed and correlated statistically. Results: Thirty patients (13-males, 17-females), aged 6-73 years (average-39.5 years) who fulfilled inclusion criteria were included. 7 (23.3%) patients had bilaterally affected ears amounting to 37 tympanosclerotic ears. left ear was commonly affected 14 (46.6%). In most patients, tympanosclerosis of tympanic membrane was an incidental finding with patients being otologically asymptomatic. The locations of tympanosclerotic patch on TM were 9 (24.4%) postero-superior, 7 (18.9%) postero-superior and postero-inferior, 7 (18.9%) antero-inferior, 5 (13.5%) posteroinferior, 3 (8.1%) antero-superior, 3 (8.1%) antero-superior and antero-inferior, 2 (5.4%) antero-inferior and posteroinferior and 1 (2.7%) entire pars tensa. Hearing level ranged from 10-46.6 dBHL (normal to moderate) with majority (91.89%) of patients had hearing within 25 dBHL. 43.3% had conductive hearing loss, 2.7% had sensorineural hearing loss and rest had normal hearing. Correlation of site of tympanosclerotic patch on TM with degree of hearing loss was not statistically significant (p=0.058). Conclusions: Variations in the site of tympanosclerotic patch on TM do not affect degree of hearing loss.
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