Temporalis fascia has long been regarded as the ideal graft material for tympanic membrane repair. However it often does not seem to withstand negative middle ear pressure in the post operative period. Tragal cartilage with perichondrium would appear to be a better graft material with good hearing outcome. It can be obtained easily with cosmetically acceptable incision. In the present study, we have compared the graft properties of temporalis fascia verses tragal cartilage perichondrium with respect to healing, hearing and rate of post operative retraction or reperforation. 132 patients of chronic otitis media with pure conductive hearing loss were posted for tympanoplasty. Temporalis fascia graft was used in 71 patients and cartilage perichondrium (composite graft) was used in 61 patients. Post operative healing, hearing and rate of retraction or reperforation was compared for both the graft materials. All the patients were followed up for 2 years. Patients where temporalis fascia graft was used, 60 (84.5%) showed a good neotympanum, 7(9.85%) had reperforation and 5(7.04%) had retraction pockets. Patients where tragal cartilage perichondrium was used, 60(98.36%) showed a healed tympanic membrane and only 1(1.63%) had reperforation. None of the patients showed retraction pocket or cholestetoma. Postoperative hearing was accessed 6 months after surgery. Patients with temporalis fascia graft showed an air bone gap of less than 10 dB in 49 (82%) patients and more than 10 dB in 11 (18%) patients. Air bone gap closure with tragal cartilage perichondrium was less than 10 dB in 45 (78%) patients and more than 10 dB in 13 patients (22%). Tragal cartilage perichondrium (\0.5 mm) seems to be an ideal graft material for tympanic membrane in terms of postoperative healing and acoustic properties. It can easily withstand negative middle ear pressure which may have contributed to the development of otitis media and significantly affect healing outcomes in postoperative period. Tragal cartilage being composed of collagen type II is also physiologically similar to the nature of the tympanic membrane.

A chronic discharging ear has been a perpetual problem and a source of worry to the otologists for centuries because of its high rate of morbidity. Active squamous chronic otitis media is a commonly encountered disease entity which requires prompt surgical management. The surgical procedure most commonly employed is modified radical mastoidectomy. This results in an 'open' cavity with its attendant problems of recurrent breakdown and discharge. Mastoid obliteration technique would appear to be the best solution for these cavity problems. Forty cases of active squamous chronic otitis media were studied. The patients were randomly divided into two groups of 20 each. The group of 20 controls had an open mastoid cavity. Out of the 20 cases, patients were divided in four groups of 5 each. For each group the mastoid cavity was obliterated with cartilage, bone dust, hydroxyapetite and Singapore swing. Healing of the cavity and the associated cavity problems in terms of pain, discharge, giddiness and wax formation, were assessed. The incidence of pain, discharge, giddiness and wax formation was markedly reduced in obliterated cavities as compared to open cavities. Healing of the cavity as evidenced by epithelialisation, at the end of 6 months, was better in those ears where cavity was obliterated (90%) as compared to those with open cavity (70%). Cases obliterated with bone dust and Singapore swing had better and early epithelialisation (100%) as compared to cartilage and hydroxyapetite (80%).

Objective To evaluate the effect of tranexamic acid, an antifibrinolytic agent, in reduction of surgical hemorrhage during endoscopic nasal surgery. Design Comparative analysis of the use of tranexamic acid in 200 patients undergoing endoscopic nasal surgery and its demonstrable reduction of hemorrhage and improvement of visibility of operative field. Subjects Around 200 patients with varied indications underwent endoscopic nasal surgery; 100 were given tranexamic acid perioperatively and 100 did not receive tranexamic acid and were used as a control. Selection of patients was done on random basis. We used the following parameters to measure intraoperative blood loss: Visibility of field of surgery, weight of blood swabs postoperatively and amount of blood from suction machine. Result Patient who received tranexamic acid showed reduction of blood loss amounting to 72.48% (p < 0.05). This reduction was compared with results published by other authors using various kinds of anesthesia. Conclusions Tranexamic acid is an antifibrinolytic agent which inhibits the action of plasmin. There is also reduction in blood level of D-dimer. It is seen to significantly reduce intraoperative blood loss during endoscopic nasal surgery. Additionally, there seems to be no alteration of coagulation parameters or untoward systemic effects. The consequent improvement in surgical field visibility is of great benefit which is encouraging and should prompt further trials.

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Aim: To compare the precision and efficacy of endoscopic control versus nasal packing in epistaxis presenting to the emergency room.Design: Open labelled randomized controlled trial for comparison of precision and efficacy of emergency blind nasal packing with primary endoscopic control of epistaxis.Subjects: A total of 160 consecutive patients of epistaxis in the age group of 40 to 70 years were randomized in two groups (A and B) of 80 patients each. Group A was subjected to blind nasal packing and group B to endoscopic procedure. About 48 (30%) patients were alcoholic, 64 (40%) were hypertensive and 48 (30%) patients did not have any overt predisposing factor. Bleeding time, clotting time, prothrombin time, partial thromboplastin time and international normalized ratio (INR) were done in all patients to rule out coagulation diseases. Results:The nasal pack of patients in group A was removed after 48 hours. The nose was endoscopically examined on 3rd day, 7th day and then 1 month after the epistaxis. A total of 44 (55%) patients of group A had nasal mucosal abrasions (p < 0.05), two (2.5%) patients had secretory otitis media (p > 0.05) and 10 (12.5%) had synechiae formation (p > 0.05). A total of 28 (35%) patients from group A had one episode of rebleed after nasal pack removal. Group B had no complications.Conclusion: Epistaxis presenting to the emergency room can be precisely and effectively controlled endoscopically. Clumsy nasal packing, complications and subsequent hospitalization costs are thereby reduced.