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INTRODUCTION: Since the days of Hippocrates, many modifications have been proposed in endonasal dacrocystorhinostomy (DCR), with the use of new drugs and implants showing variable results. The objective of this study was to analyze whether the use of silicon tubing or mitomycin C administration has an added advantage over conventional endonasal DCR. MATERIALS AND METHODS: A randomized controlled trial of 150 patients between the ages of 6 and 70 years presenting with epiphora was performed. Patients were randomly divided into three groups: endonasal DCR with mitomycin C administration, endonasal DCR with silicon stenting, or conventional endonasal DCR. Patients were followed up on Days 15, 30, 60 and 90 postoperatively for sac syringing to confirm patency. RESULTS: The majority of patients (28.7%) were in the fourth decade of life, with a female predominance (65.3%). Dacrocystitis was most commonly seen in the left eye (58.7%). An intergroup comparison was performed using the Kruskal-Wallis test at the end of 3 and 5 months. The results suggest that the success rate was significantly higher in patients with a silicone stent (P=0.04) as compared with the other two groups, although no significant difference in failure rate was seen between patients on mitomycin C and conventional therapy (P=0.132 at Month 3 and P=0.481 at Month 5, Mann-Whitney U-test). CONCLUSION: Our study shows that silicone tube stenting had a better success rate compared with the other two groups, with no significant statistical difference between the use of mitomycin C and the conventional technique.
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INTRODUCTION: The use of ossicular graft material in ossicular chain reconstruction has significantly improved hearing results hearing after tympanoplasty and tympanomastoid surgery for chronic otitis media. Today, otologists have a wide array of tools from which to choose, but may find it difficult to know which middle ear implant works best. MATERIALS AND METHODS: A prospective study of 80 patients who underwent ossiculoplasty was performed in the ear, nose, and throat (ENT) department at a tertiary health care facility from 2011 to 2013. Patients with chronic suppurative otitis media with an air-bone gap (ABG) of >25 dB with ossicular involvement were included in the study. Total ossicular replacement prosthesis (TORP), partial ossicular replacement prosthesis (PORP), and refashioned incus were used. Success was defined as ABG <25 dB on postoperative Day 90. RESULTS: The majority patients were of middle age with moderate conductive hearing loss. Incus was the most susceptible ossicle. Overall success rate in this study was 80.0% with an average change of 15.76 dB in ABG. CONCLUSION: With continuing advances in our understanding of middle ear mechanics, the results of ossiculoplasty are improving and results can be very rewarding in experienced hands. Severity of preoperative ear discharge, preoperative mastoid cellularity, presence of disease, and surgical procedure proved to be significant prognostic factors. Autograft incus and PORP fared better when the malleus handle was present while TORP gave better results when the malleus handle was eroded.
