Audiolgical results of type I tympanoplasty by underlay technique with temporalis fascia graft

To determine subjective hearing improvement experienced after closing perforation of various sizes with temporalis fascia grafts by underlay type I tympanoplasty. Prospective study. This study was conducted at the department of Ear, Nose, Throat, Head and Neck Surgery, Jinnah Postgraduate Medical Center Karachi from 01.04.2004 to 31.10.2006. 100 consecutive cases of either sex, age ranging from 18 to 40 years [mean age 31.2] of tubo-tympanic type of chronic suppurative otitis media, with dry central tympanic membrane perforation for last six weeks, having good cochlear reserve and air bone gap between 30dB to 40dB, admitted for tympanoplasty were included for this study. Patients with active ear discharge, frequently or recently discharging ear [history of ear discharge of less than 6 weeks] were excluded. Patients associated with upper respiratory tract pathologies including deviated nasal septum, sinusitis, chronic tonsillitis or pharyngitis and patients with only hearing ear were also omitted from the study. Out of the 100 patients tested, the mean air conduction threshold was 40dB preoperatively and 28dB post-operatively, while the mean bone conduction threshold remained the same pre and post-operatively i.e. 15dB. On post-operative audiometric analysis 51 ears had a post -operative air-bone gap of 10dB or less, air bone gap closed completely in 4 patients, reduced upto 15dB in 26 patients, while in the remaining 19 ears there was no improvement noted. Type-I tympanoplasty underlay technique using the temporalis fascia graft has good functional results in young patients with dry central perforation. For good hearing results, selection of cases has prime importance

Neck recurrence in early carcinoma tongue

To study the efficacy of different locoregional treatment options for tongue cancer in determining the prognosis, with reference to recurrence of disease in neck. This is a retrospective analysis of 80 patients with early [T1/T2] carcinoma tongue who had hemiglossectomy with or without neck surgery and radiotherapy for 14 years. Eighty patients were included in this study, 49 [61.3%] men and 31 [38.8%] women; 36 [45%] patients with T1 lesion and 44 [55%] with T2 lesion. Sixty two patients [77.5%] were staged cN0 and 18 patients had a clinically palpable neck nodes [cN+]. Thirty seven patients were pathologically negative [pN0], whereas 22 were pathologically positive [pN+] and 21 were not operated so they were staged pathologically [pNx] [undissected necks]. Thirty patients received postoperative adjuvant radiotherapy. The median follow-up was 16.5 months with a range of 10-120 months. The over-all rate of recurrence in neck was 32.5% [27 patients]. The rate of recurrence was 23% in T1 and 45.8% in T2 lesion [P-value 0.09] without radiotherapy. The recurrence rates with T1 lesion patients who were given adjuvant radiotherapy did not change significantly whereas with T2 lesions the recurrence rate decreased from 45% to 25% in the group without radiotherapy. Recurrence rate was higher in undissected neck as compared to patients who underwent elective neck dissection having radiotherapy and staged pN0 [P-value 0.009] or pN+ [P-value 0.005]. Patients having therapeutic neck dissection, on comparison of final pathological node staging [i.e. pN0 or pN+] the rate of recurrence in patients pN+ was 56% and in group with pN0 it was 11%, with [P-value 0.046]. We did not find any effect of age, gender and surgically resected margins of primary early tongue tumor on recurrence of disease in neck. There was no significant difference between primary tumor stage T1 and T2 lesions on neck recurrence when treated with surgery alone, but adjuvant radiotherapy further reduced the neck recurrence in T2 groups. Adjuvant radiotherapy also showed a significant reduction in recurrence rates in both pN0 and pN+. Undissected necks have higher incidence of neck recurrence than dissected neck irrespective of pathological status of neck metastasis