Which is Better for Management of Tympanic Membrane Perforation Temporalis Fascia or Fascia Lata Graft?

A good graft material is the one which is easily available and harvestable, tough and is easy to be handling and survival is good. Both temporalis fascia and fascia lata graft satisfy all these criteria. Keeping all these factors in mind, the comparative study of temporalis fascia and fascia lata graft in tympanoplasty is undertaken. All the patient reporting to ENT OPD with tympanic membrane perforation who are fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy were included in the study. Our observation and data analysis have shown that fascia lata is definitely better than temporalis fascia in terms of intactness of graft (95.1% in fascia lata and 90.24% in temporalis fascia) and PTA average improvement is higher in fascia lata graft (11.56 ± 5.005) as compared to temporalis fascia graft (10.32 ± 4.634) and ABG improvement is higher in fascia lata graft (2.7317 ± 1.118) as compared to temporalis fascia graft (2.634 ± 1.089). Fascia lata has better dimensional stability, easy handling and thickness of the graft and it provides more resistant to negative middle ear pressure. Hence, fascia lata is one of the good choices in otologist's armentorium for tympanoplasty graft material.

Study of Outcomes of Tympanoplasty Between Wet and Dry Ears in Mucosal Type of COM.

This study compares the results of Tympanoplasty in terms of graft uptake and hearing improvement in patients with Chronic Otitis Media which are divided on the basis of discharging ear and non discharging ear with perforation at the time of surgery. Total 110 patients were selected suffering from chronic otitis media. Out which 55 patients had discharging ear (wet ear) and 55 patients had non discharging ear (dry ear). Tympanoplasty was performed using temporalis fascia graft. Hearing improvement and graft uptake was seen in both wet and dry ears. No statistically difference is noted in the results between the two. Mucoid ear discharge at the time of surgery is not a contraindication for Tympanoplasty as it has no adverse effects on the outcomes of the surgery in respect to graft uptake and hearing improvement.

Outcome of Canal Wall Down Mastoidectomy: A Retrospective Review.

A canal wall down mastoidectomy (CWDM) is an effective technique for eradication of chronic suppurative otitis media (atticoantral disease) or cholesteatomas. A retrospective study was conducted at R.D. Gardi Medical college between 2015 and 2017 to evaluate the outcome of CWDM for patients with atticoantral type of CSOM. All new cases of MRM/RM which fulfilled the selection criteria were reviewed. The main outcome measures were the hearing outcome and status of dry ear postoperatively. 60 patients of CWDM (32 male, 28 female) were included for analysis. All patients in our study were between 7 and 52 years with mean age 28.38 years. The ossicular chain was eroded in all the cases. Improvement in Air-Bone-Gap was seen in 11 (18.33%), no change in 38 (63.33%) and 11 (18.33%) had deteriorated. In post operative outcome study of our 60 patients, 76.66% of the patients had dry healed cavity and non healed cavity was found to be in 23.33% of the patients. On analysis of data and comparison with other studies it was found that there are three important factors which influence hearing results and the outcome of surgery-status of ossicular chain, presence or absence of cholesteatoma, recurrence or residual disease.

Comparative Study of Hearing Results in Various Types of Tympanoplasties.

Background: This study mainly focus on hearing loss pattern in CSOM patients undergoing tympanoplasty surgery or tympanomastoidectomy pre-operatively and analysis of the outcome of the surgery in terms of improvement in hearing (air-bone gap) after 3 months of the surgery. Methodology: All patients of age 15-65 years reporting to ENT OPD with ear discharge and decreased hearing were screened with detailed history, clinical examination and microscopic examination.110 cases of tympanic membrane perforation who were fit for surgery were advised tympanoplasty or tympanoplasty with mastoidectomy. Results: Our study shows that postoperative air-bone gap closure is maximum for cortical mastoidectomy type I tympanoplasty (14.03 dB), followed with cortical mastoidectomy with type II (12.2 dB), Type I tympanoplasty (11 dB), cortical mastoidectomy with type III (7.72 dB). Procedures combined with modified radical mastoidectomy showed a very poor mean improvement in our study. Conclusion: It is very difficult to predict the results preoperatively because outcome will depend on extent of involvement of middle ear cleft by the disease process which can only be assessed intraoperatively.

Clinical and histology features as predictor of severity of mucormycosis in post-COVID-19 patients: An experience from a rural tertiary setting in Central India.

BACKGROUND: An upsurge in cases of rhinosinusitis with or without associated orbital and/or cerebral involvement by mucormycosis has been observed in post-COVID-19 patients. Our objective is to evaluate the clinical and histopathology features of these patients to determine the severity and develop a scoring on the extent on tissue invasion. METHOD: We prospectively enrolled and analyzed 95 post-COVID-19 patients who presented with the invasive mucormycosis of the head and neck region. Clinical and histology details were noted in predesigned forms. Various histology variables were graded from I to III to propose a scoring system for the severity of the disease. RESULTS: Mucormycosis was common in males with a mean age of 46.8 ± 11 years. Facial pain was the most common presenting complaint and 77% of the patients were diabetic. Most cases (n = 59) showed a moderate degree of neutrophilic infiltrate with ⩾50% tissue necrosis and angioinvasion in three or more vessels with a fungal load of 2+/3+. Histology severity grade III was observed in patients who died from cerebral mucormycosis (n = 3) and septicemia (n = 2) and in patients who had undergone orbital exenteration (n = 6). CONCLUSION: The histopathology and severity score classification was directly correlated with the outcome of the patients. Further evaluation and a larger study will help to validate the proposed scoring for its clinical use in all forms and causes of mucormycosis.

Solitary Plasmacytoma of Frontal Bone: A Case Report.

A 42 years old male presenting with complaints of swelling on the left supraorbital region since-5 months. Swelling was gradual in onset and progressive in nature. On examination it was a single swelling 5 × 6 cm, with diffuse margins, skin over the swelling was red and stretched, swelling is firm in consistency, fixed, tender on touch, non pulsatile with diffuse irregular margin. FNAC. Smears are positive for malignancy. Bone marrow examination was normal. Excision of the mass from the left frontal sinus, orbit and supraorbital region under GA and sent for HPR. Definitive treatment of choice is: radiotherary 45-50 Gy/4-5 weeks, chemotherapy and surgery. Prognosis is good with local recurrence (< 10%).

Comparative Study of Management of Attico-antral CSOM by Conventional Mastoidectomy with Inside Out Technique.

This prospective study was undertaken to compare the different aspects of inside out and conventional mastoidectomy techniques in attico-antral type of chronic suppurative otitis media. 100 cases of unsafe ear selected in this study were divided in 2 groups-(1) Group A-50 patients operated by conventional technique of canal wall down mastoidectomy. (2) Group B-50 patients operated by inside out technique of canal wall down mastoidectomy. The patients in our series were regularly followed to assess the condition of the postoperative cavity for three months. Post operative results were better by inside out as compared to conventional technique of mastoidectomy. Hearing and air-bone gap improvement was more in patients operated by inside out mastoidectomy. Less number of patients suffered with post operative residual disease like cholesteatoma, granulation, discharge and residual perforation as compared to conventional mastoidectomy.

Study of outcome of tympanoplasties in relation to size and site of tympanic membrane perforation.

There are not many studies on the effect of the site and size of the perforation on the hearing loss. This study is set to investigate the relationship between the size and site of perforation and hearing loss. This study was carried out between September 2011 to September 2013, at a tertiary care centre during which 100 cases of chronic otitis media tubotympanic type having central perforation were selected. All patients underwent, tympanoplasty using temporalis fascia/cartilage graft, underlay technique with or without simple mastoidectomy/modified radical mastoidectomy and followed up for 3 months and evaluated for graft uptake and hearing improvement with respect to size and site of TM perforation. To measure the size of perforation intra-operatively, thin transparency sheet was used, on which a graph paper of 1 × 1 mm(2) size was printed. Significant relationship was observed between size and site of tympanic membrane perforation with hearing loss. Perforations which were involving all four quadrants (AS + AI + PS + PI) are having maximum residual perforations after the surgery. In relation with size, subtotal perforation were having more residual perforations postoperatively, followed by medium sized perforations. An inherent relationship noted between ossicular involvement and hearing loss, maximum average hearing loss was observed in those cases, where all three ossicles (malleus, incus & stapes) were involved, also more hearing loss was noted in posterior perforations.

Hydrogen peroxide as 'defogger' in indirect laryngoscopy.

Indirect laryngoscopy examination is a routine clinical procedure for visualizing larynx and hypopharynx. Many methods are described in literature to prevent fogging over the mirror during the examination. Authors have used hydrogen peroxide 0.75% w/v solution as a defogging agent during indirect laryngoscopy examination and found it safe and cost effective.

Puberphonia: A novel approach to treatment.

Puberphonia affects the adolescent males. Authors have used a novel approach by using a Macintosh laryngoscope for stretching of vocal cords, which gives immediate and permanent relief. This procedure, which was incidentally found to be useful, while doing a laryngoscopic examination of a puberphonic patient, was effective and superior to any method used in the past 26 cases treated during 1991 to 2005 had been followed with the excellent results.

Cancrum Oris: A case report.

Cancrum Oris is acute gangrenous stomatitis of oral and para-oral structures in age group between 2 to 16 years particularly in sub-Saharan Africa with high morbidity and mortality. Exact bacteriology is uncertain. Acute necrotising gingivitis and oral herpetic ulcers are considered to be antecedent lesions. The treatment of cancrum oris is penicillin, tetracycline, metronidazol and clindamycin. second step of management includes reconstructive surgery for the treatment of the functional and cosmetic problems. The authors are reporting a case of cancrum oris in a 1.5-year-old child.