Comparative Study Between Single Layer and Double Layer Graft Technique in Tympanoplasty for Subtotal Tympanic Membrane Perforation

Abstract Introduction Tympanoplasty is the main treatment of mucosal type of chronic suppurative otitis media. Objective The aim of the present study was to compare clinical outcomes in terms of healing and audiological outcomes of two groups. The authors used single layer graft (perichondrium with cartilage island) graft in one group and double layer grafts (perichondrium cartilage island composite plus temporalis fascia) were used in the second group. Methods Forty patients complained of chronic suppurative otitis media safe type with subtotal perforation subdivided into two groups. The first group author used single-layer perichondrium with cartilage island graft (composite graft) while in the second group authors used double graft in the form of perichondrium/cartilage island (composite graft) plus temporalis fascia. Results There was no significant difference in the mean Air bone gap (ABG) between pre- and post-operative audiometry in subjects who had single layer tympanoplasty. There was a significant difference in the mean ABG between pre- and postoperative audiometry in subjects who had double layer tympanoplasty. There was a significant difference in in the mean ABG differences between subjects who had single layer tympanoplasty and double layer tympanoplasty. Also, there was a significant difference in the healing of the tympanic membrane between subjects who had single layer tympanoplasty and double layer tympanoplasty. Conclusion Tympanoplasty by double graft (temporalis fascia and tragal cartilage/perichondrium) achieved a considerable improvement in healing of the tympanic membrane ™ with lower risk for residual perforation or graft rejection.

Transtympanic dexamethasone treatment for control of subjective idiopathic Tinnitus

This study was done to evaluate the use of transtympanic dexamethasone treatment for control of idiopathic Tinnitus in normal hearing subjects and to determine the value of transient evoked otoacoustic emission [TEOAE] as an objective test for evaluation of the effect of this medication. 60 patient presented with tinnitus were divided into two groups, 30 patient as a study group received via ventilation tube dexamethasone hyaluranate [16 mg/ml] three times/week, every other day for a period of three months. The control group consisted of 30 patients also suffering tinnitus and received placebo. The age of each group was ranged between 20 and 50 years. All patient of the study and control group were subjected to full history as regard tinnitus, ENT examination and basic audiological evaluation [pure tone audiometry, narrow band audiometry and speech audiometry], Tinnitus matching tests and TEOAE test. All had normal peripheral hearing threshold level in spite of the presence of tinnitus. The examination were done for both study and control groups in three sessions. First evaluation was done before start of medications as a base line second evaluation after two months of treatment and third evaluation after three months at the end of treatment. The results showed no statistically significant difference in pure tone or narrow band audiometric threshold between the study and control groups after three months of medications. There was a statistically significant improvement in tinnitus matching test, [tinnitus loudness and minimal masking level] in the study group after the end of medications. Also their was statistically significant improvement in TEOAE findings [TEOAE amplitude and reproducibility and at each frequency in the study group when compared to control group at the second month and after the end of three months of treatment [80% pass response for TEOAE]. The subjective evaluation also showed 50% complete relief amid 34% change in character and intensity of tinnitus. It is concluded that Transtympanic Dexamethasone is an effective therapy for control of subjective tinnitus within three months and TEOAE test could be used as an objective test for evaluation of the effect of this medication on cochlear function in patient with subjective tinnitus

Transtympanic dexamethasone application in treatment of sudden idiopathic sensorineural hearing loss

This study was done to evaluate the effect of Transtympanic Dexamethasone in treatment of sudden idiopathic sensorineural hearing loss and to determine the value of transient evoked otoacoustic emission [TEOAE] as an objective test for evaluation of cochlear function improvement after this treatment. A total of 30 patients complaining of idiopathic sudden SNHL with age range between 20 and 50 years were examined. Full audiological evaluation was done including pure tone audiometry, speech audiometry and otoacoustic emission test were done.All patients had an average pure tone threshold between 45-65 dBHTL indicating mild to moderate SNHL mainly at high frequencies at the first evaluation before the start of treatment.The second evaluation was done after two months and the third evaluation after three months of treatment with Dexamethasone hyaluronate [16 mg/ml] using 0.2-0.4 ml at each injection daily for three months. There were significant improvement in pure tone threshold in 80% of patients and TEOAE results in 68% of patients at the third month of treatment. It is concluded that Transtympanic Dexamethasone treatment is an effective method for treatment of sudden idiopathic SNHL and that TEOAE test could be used as an objective method for evaluation of improvement in cochlear function after this treatment in patients with sudden idiopathic SNHL

Reduction of the tonsillar fossa to diminish pain after tonsillectomy

In this study, 20 consecutive patients over the age of 15 years undergoing tonsillectomy had one tonsillar fossa reduction [without suturing of the tonsillar pillars] by 3/0 vicryl suture. The opposite side was used as a control. Pain was assessed on a visual analogue scale from the first to tenth postoperative day. The study showed that tonsillar fossa reduction after tonsillectomy significantly controls the postoperative pain starting from the 5th postoperative day. Moreover, tonsillar fossa reduction is associated with more rapid and better healing and does not show any increase in the incidence rate of complications such as infections or hemorrhage. So, it is a useful, safe and easy procedure that could be used to alleviate post-tonsillectomy pain in terms of shortening of the duration of healing

Nature of hearing impairment in children of upper Egypt

In this retrospective study, a total of 12670 children, during the last ten years, from 1990 to 1999 inclusive, were examined in the ENT Department and Audiology Unit, Assiut University Hospital in Upper Egypt. The examination included, full history taking, full ENT examination and audiological evaluation [pure tone audiometry and speech audiometry when needed free field audiometry, auditory brain system response [ABR] and immittancemetry testing]. The incidence of conductive hearing loss [CHL] and mixed hearing loss were 58.8 percent of total hearing impaired children, where 22.7 percent are mixed hearing loss [12 percent of them were in need for hearing aid], sensorineural hearing loss [SNHL] was met within 41.2 percent of total hearing loss. The post febrile hearing loss was encountered as 38.5 percent and hereditary hearing loss was in 22.9 percent of total SNHL. Chronic suppurative otitis media [CSOM] accounted for 44.8 percent and middle ear effusion [MEE,] was found in 54.5 percent of total CHL. Hearing impairment in children is a significant problem in Upper Egypt. Hereditary and post febrile hearing impairment are the most common causes. Consanguineous marriage is an important factor in SNHL in children. CSOM and MEE are the most common features in CHL in children of Upper Egypt. Both factors could be prevented with certain measures which would reduce the magnitude of the problem