Determination of the Round Window Niche Anatomy Using Cone Beam Computed Tomography Imaging as Preparatory Work for Individualized Drug-Releasing Implants

Modern therapy of inner ear disorders is increasingly shifting to local drug delivery using a growing number of pharmaceuticals. Access to the inner ear is usually made via the round window membrane (RWM), located in the bony round window niche (RWN). We hypothesize that the individual shape and size of the RWN have to be taken into account for safe reliable and controlled drug delivery. Therefore, we investigated the anatomy and its variations. Cone beam computed tomography (CBCT) images of 50 patients were analyzed. Based on the reconstructed 3D volumes, individual anatomies of the RWN, RWM, and bony overhang were determined by segmentation using 3D SlicerTM with a custom build plug-in. A large individual anatomical variability of the RWN with a mean volume of 4.54 mm3 (min 2.28 mm3, max 6.64 mm3) was measured. The area of the RWM ranged from 1.30 to 4.39 mm2 (mean: 2.93 mm2). The bony overhang had a mean length of 0.56 mm (min 0.04 mm, max 1.24 mm) and the shape was individually very different. Our data suggest that there is a potential for individually designed and additively manufactured RWN implants due to large differences in the volume and shape of the RWN.

Endoscopic malleus button hole myringoplasty

<p class="abstract"><strong>Background:</strong> Myringoplasty or type-1 tympanoplasty is surgical procedure that is used for repair of the tympanic membrane. The result outcome of myringoplasty depends on several variables such as method of tympanoplasty taken whether endoscopic and microscopic, of size of perforation, bony overhang, eustachian tube function, state of the middle ear mucosa, degree of pneumatization of mastoid and technique of graft placement.</p><p class="abstract"><strong>Methods:</strong> Our study was conducted at G.G.S. Medical College, Faridkot from January 2017 to April 2018. Patients were taken for endoscopic tympanoplasty and graft was placed with buttonhole technique. Results were compared in form of preoperative audiometry and post-operative audiometry done after 3 months. </p><p class="abstract"><strong>Results:</strong> In our study patients done with endoscopic tympanoplasty with buttonhole technique graft placement showed postoperative audiometry with decreased air bone gap till 10 db in maximum number of patients and 97% patents with graft uptake.</p><p class="abstract"><strong>Conclusions:</strong> The use of endoscopes has brought a new perspective to ear surgery. The use of endoscopes along with different technique as mentioned of placing graft to prevent all the complications.</p>

Medial versus Medio-lateral Tympanoplasty in Large Central and Subtotal Perforation – A Prospective Study

Introduction: Large central and subtotal tympanic membrane (TM) perforations are difficult to repair because of less vascularity of anterior TM than posterior TM and the anterior bony overhang that blocks visualization. Some studies reported very encouraging results with the medio-lateral tympanoplasty in such cases. We have undertaken this study to find out efficacy of this technique in large central and subtotal perforations and to compare the results of medio-lateral with medial tympanoplasty. Materials and Methods: The present prospective study was conducted in the Department of Otorhinolaryngology of a medical college and hospital, West Bengal from January 2013 to December 2014. Patients were alternatively divided into two groups. Medial technique was used in Group I and medio-lateral technique was used in Group II. Results: Each group comprised of 40 patients each. Maximum number of patients in each group was in the age group of 15-25 years. The overall graft uptake rate in this study was 95% in medio-lateral technique compared to 80% of underlay technique. Conclusion: The medio-lateral tympanoplasty is suitable for reconstruction of large central or subtotal TM perforation. It takes advantage of both medial and lateral grafting methods while avoiding their pitfalls.

Surgical management of troublesome mastoid cavities

Objective:To examine the reasons for discharging mastoid cavities, the operative findings during revision surgery, and the medium-term outcome.Patients:One hundred and forty revision mastoidectomies in 131 patients were studied. Post-operatively, patients were followed up at three, six and 12 months and then yearly.Intervention:A variety of techniques were performed. Over 80 per cent of ears were treated with mastoid obliteration. Concomitant hearing restorative procedures were carried out in one-third of the ears.Results:The mastoid cavities were troublesome because of large cavity size, bony overhang, residual infected mastoid cells, the presence of cholesteatoma or perforations, and/or inadequate meatoplasty. One year after revision mastoidectomy, over 95 per cent of the ears had become completely ‘dry’ and water-resistant. Overall, 50.9 per cent of the ears had a 12-month post-operative air–bone gap of 20 dB or less.Conclusion:Revision mastoidectomy has a high success rate in converting troublesome mastoid cavities into dry, water-resistant ears.