Intra-Operative Ossicular Chain Status in Patients with Chronic Otitis Media.

The Objective of the study was to assess the ossicular status in chronic otitis media (COM)-mucosal and squamosal type and statistically evaluate the extent of ossicular destruction intraoperatively in COM patients. The findings of this study could help us to predict preoperatively the probability of having ossicular chain destruction in COM ears and thus patients could therefore be properly consented about these potential issues before surgery. The study was carried out in ENT department of tertiary health care hospital, between January 2019 to January 2020. All patients of all age groups and both genders, diagnosed with COM Mucosal and Squamosal Type with complaints of ear discharge and hearing loss with good cochlear reserve and requiring surgery were included in the study, after taking informed written consent in vernacular language. All the patients included in the study were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for ear surgery and the middle ear status and ossicular chain status were assessed using a microscope intraoperatively. Out of 98 patients, 45(45.9%) had mucosal and 53 (54.08%) had squamosal disease. Ossicular chain was eroded in 69 cases (70.5%). 23 out of 45 (51.1%) mucosal cases and 46 out of 53 squamosal cases (86.7%) reported ossicular erosion. Most frequently involved was long process of incus > stapes > malleus. From our study, we concluded that there is a significant relationship between type of disease pathology in middle ear and ossicular erosion being higher in Squamosal type of COM, with malleus being the most resistant and incus being the most susceptible ossicle.

Association of Pre-operative Eustachian Tube Function with the Graft Uptake After Tympanoplasty.

To assess the eustachian tube function by impedance audiometry (Toynbee's test) in patients of mucosal type of chronic otitis media (inactive stage) and to assess the correlation of eustachian tube function with the results-i.e., success or failure of tympanoplasty in these patients in terms of graft uptake. This was a prospective observational study carried out over one and half years in Department of E.N.T. & Head and Neck Surgery, a tertiary care hospital. The study group comprised of eighty-seven patients who were diagnosed with chronic otitis media mucosal type- inactive stage and were planned for tympanoplasty or tympanoplasty with cortical mastoidectomy. Written informed consent was taken from all patients. The eustachian tube function was assessed preoperatively by impedance audiometry (Toynbee's test). The surgical outcome was tested by looking at the status of the tympanic membrane postoperatively. The surgical outcome in terms of whether a defect was present in the tympanic membrane was compared with the preoperative eustachian tube function. 98.6% of patients with successful surgical outcome had normal eustachian tube function preoperatively while the neo-tympanic membrane was intact in 63.63% and 33.33% of patients with pre-operative partially impaired and grossly impaired eustachian tube function respectively. From our study, we concluded there was a strong association between functioning eustachian tube and graft uptake in tympanoplasty. So eustachian tube plays important role in successful outcome of surgery.

Pediatric Adenoidectomy: A Comparative Study Between Cold Curettage and Coblation Technique.

The objective of the study was to assess endoscopic coblation adenoidectomy and conventional cold curettage adenoidectomy in terms of safety and efficacy in pediatric patients. Study included 40 pediatric patients, aged between 4-17 years. 20 patients underwent cold curettage adenoidectomy and 20 underwent Coblation adenoidectomy. The 2 procedures were compared on various parameters like duration of surgery, intra-operative blood loss, and post -operative pain. To further the comparison, follow -up Nasal Endoscopy was done after 1 week and after 1 month to assess for injury to peripheral tissues and completeness of removal of adenoids. There was statistically significant difference, favouring Coblation adenoidectomy in terms of lesser intra-operative blood loss (mean blood loss of 19 mL Vs 28.5 mL) and lesser post -operative pain measured on Visual Analogue Scale (median VAS score of 2 Vs 2.67). Shorter duration of surgery (mean operative time of 10.3 min Vs 15.5 min) was the only parameter in favour of conventional cold curettage method. Injury to peripheral tissue and residual adenoid were seen in patients who underwent curettage adenoidectomy. The overall advantages of Coblation adenoidectomy when compared with cold curettage adenoidectomy are less intra-operative bleeding, less post -operative pain, completeness and preciseness of adenoid removal with minimal injury to adjacent tissues. For these reasons, Coblation adenoidectomy should be the standard technique adopted for adenoidectomy.

A Study to Assess the Effect of Size & Site of Tympanic Membrane Perforation on Hearing Loss.

The objective of the study was to assess the effect of size & site of tympanic membrane perforation on hearing loss. The study was carried out in ENT department of a tertiary health care hospital, between October 2018 and March 2020 (a total of 18 months). Patients aged 15-50 years having chronic otitis media with dry central perforation were included in the study after taking informed written consent and were evaluated with detailed history, clinical examination including otomicroscopy, tuning fork tests and pure tone audiometry. The patients were then posted for Tympanoplasty and just prior to the procedure, the tympanic membrane perforation size was measured using the Castroviejo caliper and site was noted using otomicroscopy. The status of the middle ear mucosa and ossicles were also analyzed to ensure normal middle ear mucosa and normal ossicular mobility and continuity and only then were these patients included in the study. All the patients in the study were evaluated for hearing loss using air conduction measurements in pure tone audiometry done at 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, 3000 Hz and 4000 Hz. Hearing loss was found to be directly proportional to the size of perforation in our study. The site of the perforation has a significant association with the degree of hearing loss. Those perforations with posterior quadrant involvement and multiple quadrant involvement had a higher hearing loss. From our study, we concluded that there is a significant relationship between size and site of the perforation and the amount of hearing loss.

Outcomes of Tympanoplasty Performed in Dry and Wet Ear Groups: A Comprehensive Comparative Study.

There are various factors which affect the success rate of tympanic membrane (perforation) closure, including age of the patient, size of the perforation, duration of the ear discharge, the presence or absence of infective discharge at the time of surgery. Our aim was to observe the effect of presence of discharge from the ear on the success (outcome) of tympanoplasty. This is prospective study which was conducted on 300 cases with 150 patients each in dry and wet ear group. The study was conducted on patients of age 12-65 years and of either sex presenting with chronic otitis media. Ear discharge for less than 10 years, 78% in dry ear group and 81% in wet ear group. Around 64% had complaint of decreased hearing for < 5 years in dry ear group and 60% in wet ear group. The size of perforation in dry ear group, moderate size perforation was found being predominant 46%, large in 42% and small in 12% patients. In wet ear group 46% patients had moderate, 16% patients had small and 38% patients had large perforation. Improvement in hearing was seen in 105 (70%) cases and worsening in 9 (6%) cases in dry ear group and 114 (76%) hearing improvement, 9 (6%) worsening in wet eargroup. Graft failure was 12 (8%) in dry ear and 15(10%) in wet ear. Worsening in the hearing was seen in 6% cases in both dry and wet ear groups. No other complications were noted in patients during follow up period.

Fat Myringoplasty for Small Central Perforation of Tympanic Membrane: A Prospective Study.

In fat myringoplasty, fat harvested from ear lobule is used as graft material for the closure of small size central perforation of tympanic membrane under local anaesthesia. This study was performed over a period of 5 years (January 2016-December 2020) on 67 cases who underwent surgery and were willing to participate in the study at our tertiary hospital. Closure of perforation was found in 93% of cases within 2-3 months of surgery. Hearing gain was 6.8 dB on an average and morbidity was insignificant in successful cases. Fat myringoplasty is a successful yet simple procedure for repair of small size perforations. It is a day-care procedure under local anaesthesia requiring minimal tissue handling. It is also cost effective and has minimum post-operative morbidity. The likely cause of failure are ear infections and graft displacement due to respiratory tract infections. Results of the fat myringoplasty also depend upon the experience of the operating surgeon and cooperation of the patient.

A Study of Interlay Grafting in Type 1 Tympanoplasty for Large Central Perforation.

The objective of the study was to study the outcomes of interlay type 1 tympanoplasty in large central perforations in terms of graft uptake, hearing improvement and complications. Study included 150 symptomatic patients having large central perforation in tympanic membrane willing for surgery who later underwent tympanoplasty with or without cortical mastoidectomy. All the patients selected for study, were assessed for subjective and objective evaluation pre-operatively and then post-operatively after 4 months. The study was conducted at tertiary health care hospital. Type I tympanoplasty with Interlay technique for large central perforations is superior. The Interlay technique in Type I tympanoplasty has high success both in terms of graft uptake as well as ABG closure. In the view of the advantages it offers, it should be preferred over the other conventional techniques in patients with large central perforations for better results.

Fine-Needle Aspiration Cytology: A Reliable Tool in the Diagnosis of Salivary Gland Lesions.

Salivary gland lesions comprise for about 2-6.5% of all head and neck neoplasms in adults. They are accessible for FNAC (Fine Needle Aspiration Cytology). The risk of fistula formation and/or tumour implantation are low compared to surgical biopsy. FNAC can also provide a distinction between asalivary and non-salivary lesion, benign and malignant lesions. 67 patients were studied prospectively over 5 years. FNAC was performed pre-operatively and histopathological examination post-operatively in patients who underwent surgery and were willing to participate in the study. 59.7% of the lesions were non-neoplastic and 58.2% were neoplastic (37.3% benign and 20.8% malignant). Pleomorphic adenoma was the most common benign neoplasm while mucoepidermoidand adenoid cystic carcinoma both were the most frequent malignant lesion. Among the non-neoplastic lesions, the most number of cases were of chronic sialadentis. In our study, FNAC has a sensitivity of 94.54% specificity of 80.95% for neoplastic lesions. It was seen that FNAC was a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.