Objective This study aimed to describe the microscopic over-under cartilage tympanoplasty technique, provide hearing results and detail clinically significant complications. Method
 This was a retrospective case series chart review study of over-under cartilage tympanoplasty procedures performed by the senior author between January 2015 and January 2019 at three tertiary care centres. Cases were excluded for previous or intra-operative cholesteatoma, if a mastoidectomy was performed during the procedure or if ossiculoplasty was performed. Hearing results and complications were obtained. Results
 Sixty-eight tympanoplasty procedures met the inclusion criteria. The median age was 13 years (range, 3–71 years). The mean improvement in pure tone average was 6 dB (95 per cent confidence interval 4–9 dB; p < 0.0001). The overall perforation closure rate was 97 per cent (n = 66). Revision surgery was recommended for a total of 6 cases (9 per cent) including 2 post-operative perforations, 1 case of middle-ear cholesteatoma and 3 cases of external auditory canal scarring. Conclusion
 Over-under cartilage tympanoplasty is effective at improving clinically meaningful hearing with a low rate of post-operative complications.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/815BD110D7D3B5D8E4B373CDD3ACD51E/S0022215120001978a.pdf/div-class-title-over-under-cartilage-tympanoplasty-technique-results-and-a-call-for-improved-reporting-div.pdf

Over-under cartilage tympanoplasty: technique, results and a call for improved reporting.

Background Septoplasty is a crucial step during rhinoplasty to correct the nose function and nasal aesthetics. The idea is not investigated regarding the educational purposes. Objective of the study is to evaluate the efficiency of endoscopic septoplasty during full job rhinoplasty and to observe its educational benefit. Methods Twenty-seven patients who submitted for prospective study of endoscopic septorhinoplasty operation; the analysis involves 16 female patients and 11 males. Results Endoscopic septoplasty during rhinoplasty showed an efficient illumination and visualization, which improved the precision and has an educational benefit during the reform of the posterior septum, isolated septal spurs, anterior septum, and middle turbinate attachments. Conclusion The procedure allows a precise septal job with excellent visualization of the anterior and posterior septum. It also has an intraoperative educational benefit and helps to soothe the time down of patient's recovery.

Rhinoplasty Assisted by Endoscopic Septoplasty: Precise Job and an Educational Tool.

Cartilage is used as a grafting material for tympanoplasty. The rigidity of the cartilage is the main concern. There are debates regarding slicing the cartilage when it is used as a graft. Therefore, this systematic review and meta-analysis aimed to compare the hearing results of full vs. partial-thickness cartilages in patients undergoing cartilage tympanoplasty. We systematically searched google scholar, PubMed, Cochrane, Ovid, Scopus, and gray literature including the references of the selected studies, and conference abstracts which were published up to 6 May 2020. The search syntax for identifying studies was: ((Cartilage) AND (tympanoplasty) AND (thickness)). The literature search found 1047 articles. After eliminating duplicates, 908 studies remained; from these, we excluded observational studies, reviews, case reports, and non-randomized trials, and 12 studies remained. Finally, only 5 articles were included for analysis. The pooled standardized mean difference (SMD) for the post-operative gap was −0.87 95% CI: (−1.66, −0.08) (I2 = 87.1%, p < 0.001). The pooled SMD of the reduction in gap in the full-thickness group was 2.84, 95% CI (1.39–4.3), I2 = 93.2%, p < 0.001). The pooled SMD of the reduction in gap in the partial-thickness group was 4.02, 95% CI (1.97–6.02), I2 = 95.3%, p < 0.001). The pooled results of this systematic review showed that partial-thickness cartilage graft has better hearing outcomes than full-thickness in patients undergoing cartilage tympanoplasty.

Is Cartilage Thickness Important in Cartilage Tympanoplasty? A Systematic Review and Meta-analysis

It is unusual to have communication from the external auditory canal (EAC) directly to the mastoid, totally sparing the tympanum. These patients need a different surgical approach, a modified canal wall-down procedure, to completely clear the disease but fully preserve the tympanum. We present one such exceptional case.A 28-year-old lady presented with ear discharge for 1 year. Imaging confirmed the canal-mastoid fistula, but the entire tympanum was normal. We performed a modified-modified radical mastoidectomy.Canal-mastoid fistula is an infrequent entity and may be idiopathic. Despite being evident on clinical examination, imaging aids in assessing size and location of the defect. Although EAC reconstruction may be attempted, the majority require a canal wall-down procedure. 

/pdf/modified-modified-radical-mastoidectomy-3cjhwsv4.pdf

Modified—modified radical mastoidectomy

Cartilage has undergone rapid development in ear surgery since Heermann used the grid cartilage technique to repair large perforations of the tympanic membrane. Cartilage has been widely used in tympanoplasty, ossicular chain reconstruction, reconstruction of the lateral wall of the upper tympanic cavity and the posterior wall of the external auditory canal due to its advantages of convenient sampling, high stability, good elasticity, low metabolic rate, easy survival and strong plasticity. This paper reviews the use of cartilage in tympanoplasty and discusses the possibility of placing cartilage on the stapes head for reconstruction of the auditory chain in type Ⅱ tympanoplasty.

[Application of cartilage in tympanoplasty].

/pdf/giant-rhinolith-in-a-bizarre-form-2yx9ag8f.pdf

Giant Rhinolith in a Bizarre Form

Abstract Objective This study aimed to analyse the effectiveness of using the bony sigmoid sinus plate for repair of meato-mastoid fistulae. Method A retrospective study of all cases between January 2013 and December 2019 at our secondary-tertiary centre was conducted. Inclusion criteria for study were: (1) cases with focal meato-mastoid fistulae and (2) focal meato-mastoid fistulae that were repaired by using bony sigmoid sinus plate using the bony sigmoid sinus plate technique. There were 13 cases that fulfilled these criteria. Results The outcome of the repair of meato-mastoid fistulae with bony sigmoid sinus plate was very encouraging. All 13 cases did well. Two patients had delayed epithelialisation at 9 and 12 months after surgery. Conclusion The technique of repairing meato-mastoid fistulae by using bony sigmoid sinus plate is simple, repeatable and provides effective physiological reconstruction of the posterior canal wall. Bony sigmoid sinus plate is easily and locally available in all cases undergoing cortical mastoidectomy. This plate of bone has a curvature, consistency and structure that match well with that of the posterior or superior canal wall. In addition, this technique is cost-effective with good patient compliance.

Focal meato-mastoid fistula closure using bony sigmoid sinus plate

Objective. This study aimed to analyse the effectiveness of using the bony sigmoid sinus plate for repair of meato-mastoid fistulae. Method. A retrospective study of all cases between January 2013 and December 2019 at our secondary-tertiary centre was conducted. Inclusion criteria for study were: (1) cases with focal meato-mastoid fistulae and (2) focal meato-mastoid fistulae that were repaired by using bony sigmoid sinus plate using the bony sigmoid sinus plate technique. There were 13 cases that fulfilled these criteria. Results. The outcome of the repair of meato-mastoid fistulae with bony sigmoid sinus plate was very encouraging. All 13 cases did well. Two patients had delayed epithelialisation at 9 and 12 months after surgery. Conclusion. The technique of repairing meato-mastoid fistulae by using bony sigmoid sinus plate is simple, repeatable and provides effective physiological reconstruction of the posterior canal wall. Bony sigmoid sinus plate is easily and locally available in all cases undergoing cortical mastoidectomy. This plate of bone has a curvature, consistency and structure that match well with that of the posterior or superior canal wall. In addition, this technique is cost-effective with good patient compliance.

S0022215121004473jra 151..157

Introduction Cartilage is the grafting material of choice for certain disorders of the middle ear. The indications for its routine use remain controversial due to the possible detrimental effect on post-operative hearing. Objective The present study was carried out to report a personal experience with “tragal cartilage shield” tympanoplasty to compare the results, in terms of graft uptake and hearing improvement, of endoscopic cartilage shield technique using either partial thickness or full thickness tragal cartilage for type 1 tympanoplasty and to highlight the tips for single-handed endoscopic ear surgery. Methods Fifty patients with safe chronic suppurative otitis media, assisted at out-patient department from February 2014 to September 2015 were selected. They were randomly allocated into two groups, 25 patients were included in group A where a full thickness tragal cartilage was used and 25 patients included in group B where a partial thickness tragal cartilage was used. Audiometry was performed 2 months after the surgery in all cases and the patients were followed for one year. Results Out of the total of 50 patients 39 (78%) had a successful graft take up, amongst these 22 belonged to group A and 17 belonged to the group B. The hearing improvement was similar in both groups. Conclusion This study reveals that endoscopic tragal cartilage shield tympanoplasty is a reliable technique; with a high degree of graft take and good hearing results, irrespective of the thickness. Furthermore, the tragal cartilage is easily accessible, adaptable, resistant to resorption and single-handed endoscopic ear surgery is minimally invasive, sutureless and provides a panoramic view of the middle ear.

Endoscopic cartilage tympanoplasty: full thickness and partial thickness tragal graft.

Rare Case of Nasal Tip Schwannoma - A Case Report

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