Myringoplasty: underlay versus overlay techniques- a comparative study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media is an inflammation of the mucoperiosteal lining of the middle ear cleft. 10% of Indian population suffers from hearing impairment. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study comprises of 60 patients admitted in the department of ENT and head and neck surgery, AJIMS, Mangalore between June 2015 and May 2017. All patients suffered from CSOM, tubotympanic type. Selection criteria was patients with CSOM, TTD type with no or minimal SNHL, AB gap more than 20dB, absence of ossicular defects, no history of previous ear surgery and was operated on worse hearing ear. Exclusion criteria were atticoantral disease, ossicular defects, previous ear surgery, otomycosis and systemic diseases. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">The majority of the patients were between the age group of 20-40 years. Out of the 60 patients, 28 were male and 32 female. 8 patients with moderate size and 20 with large perforations underwent underlay myringoplasty. For onlay corresponding numbers were 17 and 13. 26 patients (86.7%) who underwent underlay and 27 patients (90%) who underwent overlay had good hearing improvement. 43.3% of the group had significant hearing improvement at 6 months follow up. 20 patients had pneumatised and 40 patients had sclerotic mastoids in the study. Graft take up was 90% for underlay and 96.6% for overlay. The hearing loss was more with larger perforations.18 patients with large perforations who underwent underlay had good hearing improvement versus 13 for overlay whereas for moderate perforations, only 8 patients had good hearing improvement for underlay versus 15 for overlay. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">The hearing improvement obtained with underlay and overlay myringoplasty are comparable. The cellularity of mastoid has no influence on the hearing improvement. The size of the perforation correlates well with the degree of hearing loss. Underlay myringoplasty seems to give better results for large perforations, overlay for moderate sized ones.</span></p><p class="abstract"> </p>

Micro biological evaluation of aural swab culture and antibiotic sensitivity in 100 cases of tubotympanic and attico antral disease

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Chronic suppurative otitis media and its complications is one of the commonest ENT problems in our country. The chronicity of the disease and poor response to routine treatment prompted us to isolate and identify the causative organisms and study the antimicrobial susceptibility pattern. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">About 50 patients with tubo tympanic disease and about 50 patients with attico-antral disease were selected, complete clinical ENT examination carried out, aural swabs were collected, culture was done and antibiotic sensitivity was studied. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Culture of aural swab demonstrate the polymicrobial bacteriology consisting of both gram positive and negative pathogens, while gram negative pathogens form the majority of both tubotympanic and atticoantral disease. Mixed growth is more common in attico- antral disease. In our study, Ciprofloxacin and Cefotoxime has found out to be the drug of choice for both tubotympanic and atticoantral disease with high sensitivity. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Periodical monitoring of microbiological profile is essential for making effective empirical protocol for the cases in a particular geographical location.</span></p>

A study of mastoid pneumatisation and the presence of cholesteatoma in 393 patients

Objectives:This study aimed to evaluate the relationship between cholesteatoma formation and the degree of mastoid pneumatisation, and to assess the relationship between the location of cholesteatoma and the degree of mastoid pneumatisation.Methods:Data on all patients undergoing mastoid exploration for cholesteatoma between 1993 and 2011 were collected prospectively. Basic demographics, the degree of mastoid pneumatisation and cholesteatoma site were recorded.Results:A total of 393 patients (222 males and 171 females) underwent surgery for cholesteatoma. Patients' mean age was 37 years (range, 6–79 years). Pneumatisation of the mastoid was sclerotic in 23 per cent (n = 90), diploic in 16.7 per cent (n = 66) and cellular in 60.3 per cent of cases (n = 237) (p < 0.001). Atticoantral disease was present in 88.9 per cent of sclerotic, 95.4 per cent of diploic and 91.1 per cent of cellular mastoids. Middle-ear cholesteatoma was present in 54.4 per cent of sclerotic, 56 per cent of diploic and 51.9 per cent of cellular mastoids.Conclusion:The findings demonstrate the presence of cholesteatoma in well-pneumatised mastoids. It is hypothesised that a well-pneumatised mastoid may lead to cholesteatoma formation.

Types of pathology and ossicular status in atticoantral disease undergoing mastoidectomy at Bir Hospital

A prospective study was carried out in the department of ENT and Head and Neck Surgery in Bir Hospital, Kathmandu to know the types of the pathology and the ossicular status in atticoantral disease. This study included 100 cases of CSOM (AA) scheduled for routine mastoidectomy. In this study cholesteotoma was the commonest pathology 61 (61%) followed by granulation tissue alone in 27 (27%) cases and both cholesteotoma and granulation tissue were found in 12 (12%) cases. Ossicular damage was more common in CSOM (AA) with granulation tissue in all 27 (100%), 54(58.06%) in CSOM(AA) with cholesteotoma and 12 (12.9%) in CSOM(AA) with both cholesteotoma and granulation tissue. M+S+ ossicular defect was the commonest ossicular defect 47 (50.53%) followed by M+S-24(25.80%), M-S+13(13.97%)and M-S- 9(9.67%) cases.Journal of College of Medical Sciences-Nepal,2011,Vol-6,No-4, 26-30 DOI: http://dx.doi.org/10.3126/jcmsn.v6i4.6722

CSOM

Objective: The current study aims to find the extent of ossicular chain damage in patients with chronic suppurative otitis media,associated with cholesteotoma and/or granulation tissue formation. D e s i g n : Descriptive study. Place a n d Duration of Study: The study wasconducted at the department of ENT unit 1, Jinnah hospital/ Allama Iqbal Medical College Lahore from March, 2007 to March, 2008. Patientsa n d Methods: A total of fifty consecutive patients presenting with atticoantral disease of different age groups were included in the study. Allpatients were examined clinically and under microscope. X- rays mastoids and pure tone audiometry was done in all patients. Mastoidexploration was done in all the patients and ossicullar status was assessed peroperatively. Canal wall down procedure was adopted in all thepatients. Results: Among different age groups included, majority (more than 70%) of them, were below 30 years of age, showing thatatticoantral variant of CSOM is a disease of the young people. Males were more in number (70%). Duration of the symptoms was usuallyprolonged. On radiological examination, 39 cases (78%) had sclerotic mastoid. Audiological records of patients showed the air bone gap of morethan 40 dB in most of (78%) of patients. Perforation was marginal in most of the patients (64%). In gross pathologic findings, cholesteotomaonly, was seen in 21 cases (42%), granulations seen in 13(26%) cases, while cholesteotoma and granulations seen in 16 cases (32%). All casesshowed erosion of the ossicles, complete or partial. Incus was a most commonly involved ossicle. C o n c l u s i o n : Chronic suppurative otitis media,atticoantral variant do commonly damage the ossicles and routinely it is multiossicular damage. Incus, is damaged most with involvement ofits long process.