耳内镜下鼓膜修补术

鼓膜穿孔临床常见,外伤及中耳炎是常见原因。我们自2003年2月~2013年5月对132例鼓膜穿孔患者在电视耳内镜下进行修补,取得满意效果,现报道如下。1.1临床资料。本组患者132例,男95例,女37例,年龄15~59岁,平均35.7岁。右耳47例,左耳85例,均为单耳。外伤性90例,单纯性中耳炎42例。纯音听力测试全部为传导性聋,言语频率平均气导听阈32.5 dB。

鼓膜修补术耳屏切口改进缝合方法的病例对照研究

目的对照研究以耳屏软骨-软骨膜为修补材料的鼓膜修补术的耳屏切口的改进缝合方法,旨在改善鼓膜修补术后患者生活质量。方法采用临床病例对照研究方法,纳入笔者所在医院2015年1月~2019年1月行局麻下鼓膜修补术患者165例,均以耳屏软骨-软骨膜为修补材料,分为耳屏伤口常规加压包扎组与伤口改进缝合组,比较两组的手术时间、术后伤口甲级愈合率、术后耳廓疼痛程度。结果耳屏伤口改进缝合可明显减少耳廓疼痛程度,与常规加压包扎组比较,术后10分钟(t=3.78)、术后1天(t=5.16)和术后2天(t=5.73)时,耳廓疼痛程度改进缝合组比常规加压包扎组减小明显,差异有统计学意义(P<0.05)两组手术时间、术后伤口甲级愈合率比较,差异则无有统计学意义。结论与常规加压包扎组比较,耳屏伤口改进缝合可明显减少耳廓疼痛程度,改善术后患者生活质量,值得临床推广和应用。

耳后进路全翻内植法治疗鼓膜大穿孔

无残边的鼓膜大穿孔修补术成功率低,有些患者得不到有效的医治。我们于2003年以来采用耳后进路全翻内植法治疗无残边的鼓膜大穿孔56例（62耳）,效果满意,现报道如下。1资料与方法1.1临床资料。

鼓膜穿孔的治疗

1998-2006年我科采用不同方法治疗鼓膜穿孔178例，获得满意疗效。现总结如下。

不同鼓膜修补材料在不同鼓膜穿孔中的应用及术式选择

鼓膜穿孔是耳科常见病，主要是由中耳炎和外伤所致。鼓膜成形手术也是耳科最常见的手术之一，随着耳显微手术的发展，鼓膜成形手术在手术方法和移植组织等方面都有很大进步，从传统显微镜下手术扩展到内镜下手术：手术人路有无切口外耳道入路、耳内切口或者耳后切口人路；移植材料有颞肌筋膜、脂肪、软骨膜和软骨等。对于选择何种方法以提高成功率，仍是临床上值得探讨的问题。本文探讨根据鼓膜穿孔大小选择不同修补材料、不同术式的可行性和疗效。

Endoscopic tympanoplasty

Middle ear surgery is usually performed using a surgical microscope. Initially, in otorhinolaryngology practice, endoscopes were used for paranasal sinus surgeries. It was only later that they were applied in the area of otology. In otologic surgeries, endoscopes were first used to visualize the middle ear, before being used to assist with visualization of instruments during cholesteatoma surgeries, although they are still not used alone in various otologic surgeries. As in other surgical fields, there is also a trend towards minimally invasive intervention in the field of otorhinolaryngology. Smaller incisions performed under the guidance of endoscopes are preferred over conventional large incisions. Using this approach, improved outcomes can be achieved and postoperative morbidities can be reduced. In addition, the outcomes of grafts performed using the endoscopic approach are similar to that achieved by the microscopic approach. Therefore, endoscopic ear surgery implementations are becoming increasingly popular.

耳内镜下自体脂肪鼓膜修补术

鼓膜穿孔可引起患耳的听力下降,并增加中耳感染与后天继发性胆脂瘤性中耳炎的风险。鼓膜修补术属耳科常见手术,该手术通常在显微镜下进行。我科2005年1月～2010年9月开展硬性耳内镜下自体脂肪鼓膜修补术治疗慢性中耳炎陈旧性鼓膜穿孔和外伤性鼓膜穿孔36例,取得满意效果,报道如下。

Hearing evaluation after successful myringoplasty

Objectives: To assess postoperative hearing level, and factors that may have influence hearing improvement after myringoplasty.Methods: Twenty six cases of successful myringoplasty were included in this prospective study. Patient parameters including age, gender, size and site of the perforation, mastoid status, and etiology were evaluated. Hearing levels were assessed as the mean air conduction(AC), and airbone gap(ABG) at 500, 1000, and 2000 Hz, and their relation with aforementioned parameters were analyzed.Results: The mean AC hearing gain was 22.373 dB and mean ABG reduction was 20.733 dB. The maximum AC hearing gain was 25.93 dB for subtotal perforation and 26.24 dB for big central perforation, and the maximum ABG reduction was 25.63 dB for subtotal perforation and 24.20 for big central perforation. Mean AC hearing gain was 23.01 dB, 22.72 dB, and 21.39 dB for 500, 1000, and 2000 Hz, respectively, and mean ABG reduction was 21.52 dB, 20.79 dB, and 19.86 dB for 500, 1000, and 2000 Hz, respectively. Patient age, gender, mastoid status and etiology did not seem to have any bearing on postoperative hearing improvement.Conclusion: While patient parameters do not seem to correlate with hearing improvement following myringoplasty, the size and location of perforation appear to have an impact on postoperative hearing outcomes. Most hearing improvement appears to occur at 500 Hz.

Endoscopic transcanal myringoplasty:Is learning curve a myth?

Objective: To investigate the feasibility of transcanal endoscopic myringoplasty in the hand of young beginner surgeons who had just completed the residency programme.Methods: In a three year period(August 2012 to August 2015), 44 ears in 42 patients were operated upon by a beginner surgeon through the transcanal endoscopic approach in a subdistrict level hospital located in the north western ranges of the Himalayan region.Results: Of the 42 patient, 19 were male and 23 female. The mean age was 26.23 years(range: 15 e47 years). In 40 ears, complete perforation closure was achieved at six months(success rate: 90.9%). The mean air conduction PTA preoperatively was 40.84 dB HL and improved to 28.06 dB HL postoperatively(p <.001). The mean AB gap preoperatively was 22.40 dB, which improved to 9.1 dB postoperatively(p <.001).Conclusion: Endoscopic transcanal myringoplasty is safe and reliable even in young beginners' hands.Surgeons can consider endoscopic approach early in their careers without the fear of learning curve. The cost of endoscopic equipment is about one tenth as compared to open approach under a operating microscope, and an added advantage.

Myringoplasty Modification Adopted to Overcome Some Long and Short Term Surgical Issues

Objective/Hypothesis: We have tried to present some of our concerns regarding the usually adopted surgical techniques of Myringoplasty with their possible solutions. Also we have tried to present digital recordings of pre and post-operative findings in reference cases, which have been provided rarely in available literature. Pre- and post-operative pictures and videos of two representative cases are attached. Study design: This prospective study was carried out in MMABM hospital. Forty six (46) ears, 37 patients underwent tympanoplasty by the modified dual grafting technique and the results were analysed. Results: Objectives of tympanic membrane repair, dry ear, closure of AB gap, and stoppage of tinnitus if any, were achieved in all cases. Small residual perforations which healed over time were seen in two cases in cartilage deficient areas. Conclusion: Dual graft modified techniques served as an effective alternative myringoplasty technique.

A Comparative Study of Closure of Tympanic Membrane Perforation between Chemical Cauterization and Fat Plug Myringoplasty

The purpose of closure of small dry tympanic membrane perforations is to restore the continuity of the tympanic membrane in order to improve hearing and decrease the incidence of middle ear infections. Small and cost effective procedures like Chemical Cauterization and Fat Plug Myringoplasty have been found to be effective in healing small central perforations with significant hearing improvement. A study was carried out in 69 patients with central perforations in the Department of ENT, Gauhati Medical College & Hospital for the duration of 1 year from August 11 to July 12. Out of 69 patients, 36 underwent Chemical Cauterization and 33 Fat Plug Myringoplasty. Pre-and post-operative hearing assessments of each patient were done and statistically analyzed. The success rate was found to be 83.33% and 90.9% respectively. In both groups, there was statistically significant hearing improvement with a P value 0.01. From our study, it was found that the two procedures are simple, reliable and also lessened the morbidity of the patient. Thus we recommend the use of these two official procedures for the treatment of central perforations of tympanic membrane less than 5 mm.

Tympanometry, a Prognostic Indicator of Myringoplasty with Assessment of Eustachian Tube Function

Objective: To determine Eustachian tube function in tubotympanic type of chronic ear disease and to correlate Eustachian tube function with pathological change in middle ear mucosa. Materials and Methods: A prospective study of the cases of tubotympanic type of chronic suppurative otitis media was undertaken. Patients were subjected to clinical examination followed by audiometry tests and impedence audiometry to determine eustachian tube functions. Patients were then subjected to myringoplasty and eustachian tube function were then reassessed post operatively. Results: In our study, out of 30 cases who underwent myringoplasty, 21 cases had successful surgical outcome and 9 cases were failed. Out of 24 cases of good Eustachian tube function, 21 cases had successful surgical outcome intends of taking up graft, absence of otorrhea and improvement in hearing. In remaining 3 cases, there was recurrence of otorrhea with central perforation. All the 6 cases with poor Eustachian tube function had surgical failure. Conclusion: The prognosis of the middle ear reconstructive surgery has direct correlation with Eustachian tube functions and Eustachian tube function tests should be a routine investigation in all the cases planned for surgical reconstruction of the middle ear.

Chronic Purulent Otorrhea in the South of the Sahara: Epidemiological, Clinical and Therapeutic Profiles about 135 Cases

Objective: To study the clinical and therapeutic epidemiological profile of chronic purulent otorrhea in the ENT and CCF departments of the Gabriel Touré university hospital. Materials and Method: This was a retrospective study from May 2019 to April 2021. We made an exhaustive sampling of all patients who consulted for chronic purulent otorrhea with a complete medical file. All ages were included (except from 0 to - 5 years), and all sexes combined. The data medium was the patient records and the department’s operating report register. The non-inclusion criteria were patients with incomplete files and patients who were less than 5 years old. Results: In total, we collected 135 cases. The average age of our patients was 29.27 years. The most represented age group was 16 to 25 years old. We noted a male predominance in 60.7%. The associated signs found were hearing loss, earache, tinnitus, ear pruritus, vertigo, headache and facial paralysis. The main pathology involved is chronic otitis media (CMO) in 55.5%, the most serious of which is dangerous chronic otitis (8.1%). All of our patients have received medical treatment. The treatment was surgical in 64% of patients after medical treatment. With the mean follow-up of 6 months, tinnitus and reperforation were the most common complications found in 6.2% and 3.1% respectively. Conclusion: Chronic purulent otorrhea is the most common ear discharge in ENT consultation. The main pathology involved is CMO, the most formidable of which is cholesteatoma. Medico-surgical treatment.

Comparison between Outcome of Myringoplasty with and without Ensuring the Patency of Aditus ad Antrum

Background: Myringoplasty is a technique for the closure of the simple perforation of the tympanic membrane. For the better outcome, myringoplasty combined with cortical mastoidectomy has been tried in many studies. Objectives: To compare the outcome of repair of tympanic membrane perforations with myringoplasty alone versus myringoplasty with opening of blocked aditus if any by doing antrostomy. Methodology: This was a prospective study. Patients included in the study were randomly allocated into 2 groups, the group I and the group II. The group I included 17 patients undergoing myringoplasty with antrostomy and the group II included 17 patients undergoing only myringoplasty. The blocked aditus was made patent if it was found blocked during antrostomy procedure. Graft uptake rate and improvement in conductive hearing loss were measured as success rate. Results: Mean age of the patients in the group I was 23.12 ± 7.55 years. The mean age of patients in the group II was 25.53 ± 8.79 years. In the group I unilateral disease was present in 6 (35%) cases. In the group II unilateral disease was present in 12 (70.5%) cases. In the group I subtotal perforation was present in 9 (52.9%) cases and moderate to large perforation was present in 8 (47%) cases. In the group II subtotal perforation and moderate to large perforation were present in 9 (52.9%) and 8 (47%) cases respectively. Aditus was found to be blocked in eleven (64.7%) patients in the group I. Successful graft uptake was seen in twelve cases (70.58%) in the group I and eleven cases (64.7%) in the group II with all of them showing improvement in hearing. The success rate of the group I was 70.58% while success rate of the group II was 64.7%. The mean of pre-operative and post-operative air-bone gap was 31.94 ± 11.7 dB and 24.8 ± 10.55 dB respectively in the group I with the mean hearing gain of 7.06 ± 3.9 dB. Similarly, the mean of pre-operative and post-operative air-bone gap was 28.24 ± 10.5 dB and 17.9 ± 0.08 dB respectively in the second group with the mean hearing gain of 10.29 ± 4.83 dB. Conclusion: There was no difference between success rate of myringoplasty with antrostomy group and myringoplasty alone group in the treatment of mucosal tympanic membrane perforation;however in majority of cases where aditus patency was checked (group I) it was found to be blocked (64.7%).