CLINICO-AUDIOLOGICAL STUDY OF OTOENDOSCOPIC TYMPANOMEATAL DEGLOVING TECHNIQUE TYMPANOPLASTY IN KASHMIR - A PROSPECTIVE STUDY
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Keywords
CSOM, Tympanoplasty, Tinnitus and Otalgia, Autogenous temporalis fascia graft, AB gap closure, Tragal perichondrium graft.
Abstract
Background: Chronic suppurative otitis media (CSOM) constitutes a major public health problem in children and adults in the developing world. Tympanic membrane perforations are seen often in daily clinical practice and results from events such as: otologic infection, trauma, or after placing grommets. Different types of tympanic membrane perforation include (i) Central, (ii) Marginal, (iii) Attic, (iv) Subtotal, and, (iv) Total. Endoscopic management for perforations involving more than 50% is challenging but by the introduction of the newer degloving tympanomeatal flap technique the issue is solved.
Objectives: The present study was conducted to evaluate the outcome of otoendoscopic tympanomeatal degloving technique tympanoplasty in management of subtotal and total tympanic membrane perforations.
Methods: Patients having safe type of CSOM with tympanic membrane perforation involving more than 50% of pars tensa with conductive hearing loss for evaluation and management during the study period were taken for the study. Patients with safe type of CSOM with >50% tympanic membrane defect with conductive hearing loss were included in the study, and, the middle ear was dry for at least 6 weeks.
Results: Ear discharge and hearing loss were the presenting symptom in all studied subjects. Tinnitus and Otalgia were associated symptoms seen in 2 (4.4%) each. On pure tone audiogram (PTA), 31 (68.9%) patients had preoperative AB gap of 31-40dB and 14 (31.1%) had AB gap in the range of 21-30 dB. All patients underwent otoendoscopic Degloving technique tympanoplasty type I. Autogenous temporalis fascia graft was used in 43 (95.6%) patients whereas tragal perichondrium graft was used in only 2 (4.4%) patients. Postoperative AB gap closure was compared at 3 months and 6 months follow up with a mean AB gap closure of 24.8+1.752 at 3 months and 25.5+1.584 at 6 months follow up. Graft was intact in 42 (93.5%) patients at 3 months follow up. Small residual perforation was seen in 3 (6.7%) patients at 3 months follow up which healed spontaneously and graft was intact in all 45 (100%) patients at 6 months follow up. In postoperative period follow up, 2 of the study subjects developed infection which was managed conservatively.
Conclusion: Otoendoscopic tympanomeatal degloving technique for tympanoplasty is new technique which showed good results in terms of postoperative graft uptake and also has good postoperative hearing results. It is cosmetically better as less tissue injury is involved in the procedure and recovery is fast.
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Dr. Radiya Manzoor (MD)
Senior Resident, Department Of Anatomy, Government Medical College, Anantnag, Kashmir
Dr. Showkat Ahmad Showkat (MS)
Professor, Postgraduate Department of ENT & HNS, Government Medical College, Srinagar Kashmir
Dr. Bilal Shafiq Dar (MS)
Postgraduate Department of ENT & HNS, Government Medical College, Srinagar Kashmir