Study of Correlation of Pre-Operative Findings with Intra-Operative Ossicular Status in Patients with Chronic Otitis Media

Introduction: Chronic otitis media (COM) has been broadly classified into mucosal and squamous subtypes. COM types are associated with erosion of the ossicular chain. The aim of the present study was to correlate the type of COM, the site of perforation/retraction, and the type of disease pathology with the pattern and degree of ossicular chain necrosis.   Materials and Methods: A prospective cross-sectional study was performed in 76 cases of COM, who were subjected to tympanomastoidectomy. Pre-operative findings were compared with per-operative ossicular chain status and pathology.   Results: Incus was found to be the most vulnerable ossicle for erosion, followed by malleus and suprastructure of stapes. The pattern of multiple ossicle involvement was more common. Ossicular chain erosion was more common in squamous COM than mucosal COM (X2=66.25; P=0.0001) and in the presence of cholesteatoma and granulations. Ossicular necrosis was most common in squamous disease with cholesteatoma, followed by squamous disease with granulations, mucosal disease with granulations, and inactive mucosal disease in that order.   Conclusion: The degree of ossicular necrosis has a positive correlation with the type of disease pathology, being higher in squamous disease than in mucosal disease. The pattern of ossicular necrosis varies with the site of origin of the disease and the pattern of spread of cholesteatoma, being variable for pars tensa and pars flaccida squamous disease

Middle Ear Function Changes due to the Combined Effect of Pressure along with Fluid in Middle Ear Pressure Regulation- A Review

The pressure changes in Middle Ear (ME) are due to the effect of both fluid and pressure, which can be detected by tympanometry. In this review article, the mathematical and formal model of regulation of ME pressure is discussed. The air pressure in the ME chamber and the surrounding environment are the same. The auditory tube is a common connection between the ME chamber and the nasopharynx. The main functional role of the auditory tube is the ventilation of ME. When a person breathes air through an auditory tube, it enters into the ME and ventilates it. The ossicles in the ME collect sound from the tympanic membrane and transfer it to the inner ear, which requires proper ventilation of the ME. The auditory tube maintains ME pressure, the same as the external auditory canal and outside pressure. If an auditory tube is blocked, it leads to failure to ventilate ME, leading to changes in ME pressure. Swallowing and yawning allow the passive opening of the auditory tube and thus results in air flow out of the chamber. Easy and passive air exchange is allowed from the ME to the pharynx if, the pressure in the ME is higher than in the surrounding environment. ME pressure is highly variable and can change in many conditions. ME pressures increase when the body rotates from a vertical to a horizontal position because it increases the effusion of the ME mucosa due to an increase in hydrostatic pressure, which leads to an increase in the perfusion rate. Therefore, pressure increases in the case of sleeping and drowsiness. Regulation of ME pressure is a physiological process in which pressure between ME and the surrounding environment is maintained at equilibrium. The mechanism of pressure regulation is possible because of the complex sensory neural reflex pathway. A laser doppler vibrometer measures displacement of the tympanic membrane in response to sound and ME compliance is calculated by tympanometry. The movement of the tympanic membrane reduces due to the combined effect of fluid and pressure on the ME. The ME functions are altered due to the negative pressure of the fluid rather than the positive pressure

Comparative study of video demonstration versus traditional demonstration of skills in postgraduate students of otorhinolaryngology at tertiary level rural hospital

Introduction: Ever expanding patient expectations, increasing expense of operating room time, trainee work-hour restrictions and the application of less invasive techniques have all contributed to lessening opportunities for teaching surgical skills. Just as operating room experience is becoming more precious for residents, medical students typically receive much less teaching and evaluation of their surgical skills during their clinical rotations. Computer-assisted instruction is being used more and more to deliver educational material, particularly in medical schools. Potential reasons for adopting this technology include increased efficiency, portability, consistency, and effectiveness. Material and methods:An Interventional and Comparative study was undertaken in the Department of ENT & HNS at the tertiary level rural hospital. Total duration of the study was 24 weeks. Overall 4 procedural skills were selected. Total sample size of study was 28. Crossover was done among the groups. Both the Groups A and B were assessed by Senior Staff (Postgraduate Teacher) on the prestructured rating form of Direct Observation of Procedural Skills (DOPS.). The result among the two groups were analysed by applying unpaired t-test.Results : In DNE, 50% students were found in both satisfactory and good grading following video demonstration. In VDL, 66.70% students were found in good grading and 33.30% students were found in satisfactory grading. In EUM, 75% students were found in good grading and 25% students were found in satisfactory grading. In Mastoid Bandage, 100% students were found in good grading. Out of the total 14 students who were exposed to video demonstration showed 28.6% students having satisfactory grade and 71.40% students having good grade and no student in poor grading.Conclusion : Video Demonstration of Otorhinolaryngological Skills is a effective method of teaching and it improves attitude and professionalism in the students and enhances surgical acumen among them

Surgical Outcomes of Tympanoplasty with Various Graft Materials in Chronic Otitis Media: A Retrospective Cohort Study

Introduction: Chronic Otitis Media (COM) is a common ear disorder that predominantly affects underdeveloped countries. It is characterised by persistent middle ear discharge and a perforated Tympanic Membrane (TM). Management typically involves antibiotics and surgical techniques like tympanoplasty to eradicate infections and improve the auditory conduction system. Various graft materials are used, with temporalis fascia being preferred due to its proximity and ease of harvesting. Aim: To evaluate the surgical outcomes of tympanoplasty procedures utilising different graft materials in patients diagnosed with inactive mucosal COM. Materials and Methods: This retrospective cohort study was conducted in the Department of Otorhinolaryngology at Acharya Vinoba Bhave Rural Hospital (AVBRH), Wardha, Maharashtra, India, between June 1, 2013, and May 31, 2023. A total of 165 participants with inactive mucosal COM, who had small to subtotal central perforations of the TM, were included. Tympanoplasty, performed by the same surgeon using the Zeiss surgical microscope model OPMI under general anaesthesia, was the chosen surgical procedure. All cases were executed using the postauricular approach with the underlay technique. A successful anatomical outcome was defined as an intact neo-TM without residual perforation at the end of a three-month follow-up. Results: The age of participants ranged from 10 to 75 years, with a mean age of 32.45±14.06 years. The age group most frequently affected by mucosal COM was between 31-40 years, comprising 41 (24.85%) cases. Large perforations were observed in 79 (47.88%) patients, followed by moderate perforations in 65 (39.39%) patients. Normal ossicular chains were found in 163 (98.78%) patients, while ossicular erosion was noted in 2 (1.22%) patients during surgery. A total of 118 (100%) patients who came for follow-up, 84 (71.19%) who underwent temporalis fascia graft reconstruction showed successful graft uptake. Conclusion: This study found that both fascia and cartilage tympanoplasty are suitable for TM repair due to their availability

Association of various factors related to mastoid buffer and middle ear ventilation in etiopathogenesis of squamous chronic otitis media—a cross-sectional study

Abstract Background Active squamous chronic otitis media (COM) is an entity with a deep retraction pocket of the pars tensa or flaccida that has retained debris of squamous epithelial where the fundus cannot be visualized involving the pars flaccida or pars tensa, associated with cholesteatoma. Eustachian tube dysfunction (ETD) is a known etiological factor for squamous COM, based on Wittmack’s theory; however, there are very few recent studies in this regard. Contracted mastoid pneumatisation (diploic or primary sclerosis) and presence of Korner’s septum have also been implicated to be associated with middle ear pathology, with conflicting results. Hence, the present study was undertaken to find out the association of three important factors, namely eustachian tube dysfunction, type of mastoid pneumatisation, and Korner’s septum related to mastoid buffer and middle ear ventilation in etiopathogenesis of active squamous chronic otitis media. The study also attempted to identify various conditions of nose and nasopharynx associated with ETD. This would enable us in appropriate surgical decision making with long term benefits in term of hearing and disease outcomes. Results Out of the total 37 patients, with active squamous chronic otitis media, it was observed that Eustachian tube dysfunction was found to be associated with 23 (62.16%). The majority of patients had a diploic/primary sclerosed mastoid pneumatization pattern which is 32 (86.48%) of patients. Korner’s septum was found to be associated with 13 (35.13%) patients of the total 37 patients with active squamous chronic otitis media. All these findings were found to be statistically significant. Conclusion In this study, we found that there was a statistically significant positive association of all etiological factors namely Eustachian tube dysfunction, contracted mastoid (diploic/primary sclerotic mastoid), and the presence of Korner’s septum with causation of active squamous otitis media. Out of these factors, occurrence of diploic mastoid seemed to be the most constant association. Eustachian tube dysfunction of mechanical type, associated with various nasal pathologies, most common was, deviated nasal septum