Ranjani Subha, R (2022) Endoscopic Assessment of Patency of Ventilation Pathways in Type 1 Tympanoplasty in Permanent Perforation Syndrome. Masters thesis, Madras Medical College, Chennai.
|
Text
220400122ranjani_subha.pdf Download (3MB) | Preview |
Abstract
INTRODUCTION: Myringoplasty or type 1 tympanoplasty is one of the most common otologic surgical procedures done. A case of chronic suppurative otitis media-permanent perforation syndrome (inactive mucosal disease - > 6 months) wherein a simple closure of the tympanic membrane perforation done does produce hearing improvement but tympanoplasty has to be done taking into consideration the various functional aspects of the middle ear cleft. AIMS AND OBJECTIVES: 1. The structural anatomy of the mesotympanum, retrotympanum including the ponticulus, subiculum, sinus tympani and epitympanic ventilatory pathways. 2. The status of the epitympanic diaphragm including the type of tensor tympani fold, patency of anterior and posterior isthmi, using angled endoscope in permanent perforation syndrome during type 1 tympanoplasty. MATERIALS AND METHODS: Study Design: Observational cross sectional study Study Setting: The study was conducted at Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Chennai – 600 003. Study Sample: 30. Ethical Committee Clearance: Obtained from the Institutional ethical committee. Study Period: December 2020 – December 2021. TECHNIQUE: Tympanoplasty - type 1 is performed in the selected cases of permanent perforation syndrome under study.During tympanoplasty, along with ossicular chain integrity the upper mesotympanum is inspected using 0 deg hopkins rigid rod lens endoscope. The mucosal folds along the malleus (posterior malleal ligament) are visualised. Using a 45 deg hopkins rigid rod lens endoscope tensor tympani fold along with Eustachian tube is visualised.Placing it anteriorly and superiorly to the handle of malleus the epitympanic diaphragm is visualised and tympanic isthmi (proctors anterior and posterior isthmus) are studied.Retrotympanum is endoscopically assessed including the ponticulus, subiculum and sinus tympani.Hence the epitympanic diaphragm is endoscopically assessed along with neighbouring mucosal folds. DATA COLLECTION: 1) Complete history and clinical examination. 2) Pure tone audiogram. 3) HRCT temporal bone. 4) Endoscopic assessment. INCLUSION CRITERIA: 1) Age group: 18- 50 years. 2) Both sex- male and female. 3) Patients presenting to OPD with a. Conductive hearing loss: <40 dbHL b. No active discharge- inactive mucosal disease. c. Dry ear - 6 months. 4) Normal middle ear mucosa. 5) Preliminary plan -type 1 tympanoplasty. EXCLUSION CRITERIA: 1. Age group:extremes of age. 2. Hearing loss- >40 dbHL. 3. Wet ear. 4. Thick, pink/reddish middle ear mucosa. CONCLUSION: ❖ Till now abundant literature is available regarding the epitympanum and isthmi status in atticoantral disease. ❖ Our study decribes the various middle ear structures identified during endoscopic tympanoplasty that are vital in identifying the ventilatory mechanisms and which are not feasible with microscopic views. ❖ In our study eustachian tube patency was 90% , 80% had complete tensor tympani fold, 16.7% had anterior isthmus blockage, 20% had posterior isthmus blockage , 33.3% had edematous middle ear mucosa. ❖ We would like to propose that with patent eustachian tube, permanent perforation syndrome can be present with tympanic isthmi blockage which leads to persistence of disease. ❖ We also suggest that with usage of angled endoscopes we could alleviate the need of mastoidectomy in permanent perforation syndrome with identifying the ventilatory status and type of isthmus blockage.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221914021 |
| Uncontrolled Keywords: | Endoscopic Assessment, Patency, Ventilation Pathways, Type 1 Tympanoplasty, Permanent Perforation Syndrome. |
| Subjects: | MEDICAL > Otolaryngology > MEDICAL > Otolaryngology |
| Depositing User: | Subramani R |
| Date Deposited: | 22 Apr 2022 15:04 |
| Last Modified: | 17 Dec 2023 07:30 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/19377 |
Actions (login required)
 |
View Item |
