Influence of size of tympanic membrane perforation on outcome of myringoplasty

The objective of this study was to determine the influence of size of central tympanic membrane perforation on outcome ofmyringoplasty. Descriptive-Interventional Study. ENT Department PNS SHIFA Karachi. The study was completed in seventeen months from 22nd August 2009 to 22nd Jan 2010. The study consists of 60 cases. Non-Probability Convenience Sampling. After obtaining informed consent sixty patients undergoing myringoplasty at PNS SHIFA Karachi during the study period fitting the inclusion criteria were selected. Patients were examined and the size of tympanic membrane perforation was recorded. Perforation up to two quadrents was labeled as small perforation, three quadrents as large perforation and four quadrents labeled as subtotal perforation. The patients were managed by myringoplasty using Endaural incision with underlay technique to place the graft harvested from Temporalis fascia under General Anesthesia. All surgeries were performed by second author [senior consultant surgeon]. After undergoing myringoplasty patients were followed in ENT OPD on 2nd week to check the status of ear after removal of BIPP and eight weekly interval to check complete healing of graft for final result.:After 8wks 100% [n=20] patients with small perforation, 85% [n=17] with large perforation and 60% [n=12] with subtotal perforation had perfect healing and graft was intact. Smaller perforations have a greater chance of healing after surgery

Tympanic membrane disintegration by otomycosis

To report ear drum disintegration in cases of otomycosis. Case series study. E.N.T and Head and Neck Surgery Department PNS Shifa Hospital Karachi and E N T Department of Combined Military Hospital, Quetta Cantt from August 2009 to October 2010. 242 patients with clinical diagnosis of otomycosis were registered over a period of 15 months. On registration ear was meticulously cleaned under microscope removing fungal debris to establish the integrity of eardrum. In the same sitting cream with combination of triamcinolone acetonide, neomycin sulphate, gramicidin, nystatin was applied all around within external auditory meatus [EAM] on effected walls and same drops were advised locally thrice daily for 3 to 5 days. Every patient was advised to report back immediately on occurrence of irritation, earache, ear discharge, blockage of ear and pain. Out of 242patients [140 males and 102 females] 110 [45.45%] were cured after single visit as outpatient adopting a regimen of single application of antifungal cream and thrice daily antifungal ear drops for 5 days after proper cleaning of fungal debris from EAM. 73 [30.16%] cases were cured of otomycosis after two sittings of same regimen. 59 [24%] patients neglected the otomycosis for days to weeks till the time pain became unbearable. In 18 [7.43%] patients ear drum was perforated by otomycosis and all these patients had neglected the disease. Neglected Qtomyeosis has all the potentials to create a defect in ear drum causing chronic disability .Meticulous cleaning and local antifungal therapy still remains the gold standards for curing otomycQsis

Anatomical and functional outcome following type-1 tympanoplasty in chronic tubotympanic suppurative otitis media

To assess the improvement in hearing and rate of graft uptake after type-1 tympanoplasty in chronic tubotympanic suppurative otitis media and to identify the complications of surgery. Interventional study [quasi experimental]. Department of Ear Nose Throat [ENT] and department of Head and Neck surgery at Combined Military Hospital [CMH] Rawalpindi from July 2002 to Feb 2004. A total of 107 cases of chronic suppurative otitis media tubotympanic type with dry central tympanic membrane [TM] perforations were selected. Out of these, 85 cases were available for follow-up. The patients were evaluated by history, clinical examination and by examination under otomicroscope. All other cases with ear discharge and cholesteatomas were excluded. Preoperative and postoperative audiograms were done, laboratory investigations and X-ray of mastoids were also carried out. All the patient underwent type-I tympanoplasty, using temporalis fascia with underlay technique. The postoperative results were evaluated with respect to anatomical and functional out come. Our study showed an overall success rate of 92.95% as far as the graft uptake was concerned. Out of 85 cases, on examination at the interval of three months the perforations was closed in 79 [92.94%] cases. Improvement in hearing was seen in 73 [85.88%] cases, with notable reduction in air-bone gap at the end of three months. The complications at the interval of three months were dislodgement of graft 1 [1.17%] case, residual perforation 5 [5.88%] cases, deterioration of hearing 1 [1.17%] case, small retraction pockets 3 [3.52%] cases and metallic taste in mouth 2 [2.35%] cases. From this study we concluded that in dry ears with central perforations, type-I tympanoplasty using temporalis fascia with underlay technique is a very satisfactory and reliable procedure for closing the tympanic membrane perforations and to restore hearing, provided attention is paid to aseptic technique, anatomical landmarks and by exercising good clinical judgment