The aim of this study is to evaluate the results of closure of big central and subtotal perforation by Tympanoplasty using underlay technique with Composite graft of tragal perichondrium supported by a ring of cartilage peripherally. Our hypothesis was that the cartilage support offers an extremely reliable method for reconstruction of the tympanic membrane in cases of advanced middle ear pathology and Eustachian tube dysfunction and also revision cases. Prospective study of patients undergoing tympanoplasty in big central and subtotal perforation with graft supported by a ring of cartilage peripherally between June 2016 and August 2016. Hearing results were reported using four frequency (500, 1000, 2000 and 3000) pure tone average air-bone gap. During the study period, composite graft comprising of tragal perichondrium and peripheral ring of cartilage prepared from ipsilateral tragus was used for tympanic membrane reconstruction in 30 patients. Overall graft take rate was 93.33%. Complications included residual perforation in 6.67%. Cartilage ring support offers an extremely reliable method for reconstruction of tympanic membrane in cases of high-risk perforation (big central perforation, subtotal perforation, anterior perforation of tympanic membrane, revision cases).
Introduction
Autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) are commonly used for ossicular chain reconstruction. The present study attempts to assess the post-operative outcome with these two prostheses.
Materials and Methods
A Randomized prospective study was conducted in Tertiary referral care hospital to determine which material, among autologous reshaped Incus and Teflon partial ossicular replacement prosthesis (PORP) gives better postoperative hearing result in Ossiculoplasty.
Patients presenting at outpatients’ department with the clinical diagnosis of chronic otitis media with perforation or retraction. The study population consisted of a total of 50 patients. Ossiculoplasty with reshaped Incus or PORP was performed after Canal Wall Up mastoidectomy. Hearing results were measured by Air-Bone gap in PTA after 6 months of surgery.
Results
Selecting the criteria <20 dB ABG as success when Stapes superstructure is present, Incus has 64.29% success rate, whereas PORP has 31.81% success. Extrusion rate of different prosthesis shows PORP has 18.18% extrusion whereas autologous Incus has lower (7.14%) extrusion rate.
Conclusion
Among these two ossiculoplasty materials, autologous Incus gives better postoperative hearing gain and lower extrusion rate.
<p><strong>Background:</strong> Aim of the study was to compare the outcomes of a new technique of mastoid cavity obliteration with open mastoid cavity.</p><p><strong>Methods:</strong> 90 patients diagnosed with chronic otitis media (active squamosal variety) and planned to undergo surgery between 2016-2018 were randomly assigned into two groups of 45 patients. One group underwent canal wall down matoidectomy followed by cavity obliteration with posteriorly based vascularised flap with mastoid cortex periosteum plus conchal cartilage composite graft and the other underwent the same surgery but without any obliteration. The two groups were compared in terms of cavity volume, discharge, epithelisation, wax formation, subjective sensation of vertigo and post-operative air-bone gap at 1 year.</p><p><strong>Results:</strong> Cavity obliteration in post-canal wall down setting significantly reduced the post-operative cavity volume and need for cavity debridement with better epithelisation, less incidence of discharge, vertigo on caloric stimulation when compared to open cavity. The post-operative air-bone gap in obliterated cavities was better but not statistically significant.</p><p><strong>Conclusion: </strong>Cavity obliteration has definite advantages over open cavity in terms of healing but no significant differences in long-term audiological outcomes.</p>
Objective
To compare endoscopic epitympanic exploration with conventional canal wall up (cortical) mastoidectomy for mucosal chronic otitis media in terms of post-operative outcomes.
Methods
Seventy-six patients diagnosed with chronic otitis media (mucosal variety) were randomly assigned to two treatment groups: endoscopic epitympanic exploration and conventional canal wall up (cortical) mastoidectomy. The groups were compared in terms of: post-operative anatomical outcomes (graft uptake), middle-ear physiological outcomes (post-operative tympanometry), audiological outcomes (air–bone gap), surgical time, post-operative pain, vertigo, and long-term complications such as retraction pocket and re-perforation.
Results
There was a statistically significant difference between the groups in terms of mean air–bone gap at 12 months, surgical time, and median post-operative pain measured at 6 hours (p < 0.05). No statistically significant differences were noted in terms of: graft uptake at 1, 3 and 6 months, mean air–bone gap at 3 and 6 months, tympanometry at 3, 6 and 12 months, vertigo at 1 week, or long-term complications.
Conclusion
Endoscopic epitympanic exploration resulted in significantly better long-term audiological outcomes, shorter operating time and less pain compared with conventional canal wall up (cortical) mastoidectomy.
Introduction
Deviated nasal septum (DNS) can be asymptomatic in an individual or may cause nasal obstruction. The condition is generally diagnosed clinically and based on clinical diagnosis it is managed Surgically by large without much heed to diagnostic procedure. Thus, often underlying other causes of Obstruction is missed. Thus, it becomes essential to evaluate every patient presenting with history of Nasal obstruction and clinically Deviated septum, with aid of Nasal Endoscopy and CT scan Nose Paranasal Sinuses (PNS) to rule out/diagnose other coexisting conditions.
Methods and Methodology
100 patients who presented with nasal obstruction and clinically diagnosed to have Deviated Nasal Septum were then subjected to Nasal Endoscopy and CT scan Nose and PNS and findings were noted for analysis.
Results and Analysis
Of these 100 patients, 48 patients were found to have coexisting pathological conditions/anatomical variants. Various anatomical and pathological Conditions were found to coexist together. Inferior turbinate hypertrophy in 34% is the most common pathological condition found to be associated with DNS followed by of sinusitis in 25% patients apart from polyp, concha bullosa and paradoxical middle turbinate.
Discussion
Studies done so far shows there is a definite link of deviated nasal septum to various anatomical and pathological conditions of the nose. CT Scan Nose PNS and Nasal Endoscopy plays a vital role in diagnosing such anomalies.
Conclusion
Most of the patients, presenting with nasal obstruction and having Deviated Nasal Septum, undergo management without proper analysis and returns with recurrence of symptoms which could be analyzed properly if Nasal endoscopy and CT scan is employed during diagnosis of the condition, reducing risk of treatment failure.
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