MATERIAL AND METHOD
This was a prospective study carried out between January 2019 to January 2020.
INCLUSION CRITERIA
  1. Patient with H/O ear discharge
  2. All Tubo- tympanic diseases
  3. Young adults to age up to 70 years
  4. Dry/ mucoid /mucopurulent discharge
  5. Conductive, Mixed or Sensorineural hearing loss
EXCLUSION CRITERIA
  1. Attico antral disease
  2. Ossicular chain dislocation
  3. Ossicular chain fixation
METHODS
All patients with history of ear discharge were given a course of Tab Amoxycillin+ Clavulanic acid 625 mg three times daily for five days. Aural swab was sent for culture and sensitivity. Pure Tone audiometry and Eustachian tube function test was done in all cases. All cases underwent X-ray Mastoid (Lateral Oblique view). The antibiotic was switched as per the culture and sensitivity report and continued for next five days, although dryness of ear was not a criterion for surgery. Patients underwent Endoscopic myringoplasty with intravenous antibiotic, oral antihistamine one day prior to surgery in wet ear cases. The patients were followed up one week, one month and three months post-surgery. Endoscopic examination of the patient post one month and three months. Intact graft after 1 month of surgery was taken as anatomical success [1]. Audiometric evaluation was done on third month post op.
PROCEDURE
All cases were done under general anaesthesia. Rigid endoscope 00 ,2.5 mm was used to visualize the tympanic membrane. We had used the same microsurgery instrument that were used for Microscopic Myringoplasty. Patient were laid in supine position, head rotated to the opposite side and supported with a head ring. Separate incision, post auricular just adjacent to the hairline measuring 2.5 to 3 cm was given to harvest the Temporalis facia. The graft was “paper dried”. All cases were supervised by a single surgeon and performed by postgraduate residents.
TECHNIQUE
The external auditory canal was infiltrated with 2% 1:200,000 xylocaine with adrenalin using Insulin syringe just distal to the hairy part along the circumference until one can notice the blanching of the skin. A maximum of 5ml was used for infiltration. We had used ample of adrenalin soaked cotton balls to achieve haemostasis and in all cases, we have achieved bloodless field which is very important for endoscopic myringoplasty other than the technicality. Tarabichi suturing at the concha was done to straighten the cartilaginous external auditory canal. All cases were done with surgeon in sitting position with the elbow of the endoscope holding hand resting on the table which provided stability. Margins of the Tympanic membrane remnant was freshened with curved pick or sickle knife. Tympanomeatal flap raising was tailor made as per the site of the Tympanic membrane perforation as illustrated in the diagram below. Diagram1 depicting a perforation in the anterior quadrant with sufficient anterior margin, here an anterior tunnel was created just close to the annulus with Tympanomeatal flap raised from 12 ‘o’clock to 6 ‘o’clock and the part of the graft was taken out from the tunnel to prevent anterior blunting. Diagram 2 a condition where the perforation was in the posterior quadrant, here the tympanomeatal flap was raised from the 12’o’clock to 6’o’ clock and the graft was placed medial to the malleus. Diagram 3 showing a subtotal perforation with very thin anterior remnant, here the Tympanomeatal flap was raised from 11’o’ clock round the circumference to 2 ‘o’ clock and a big graft was placed resting over the bony canal throughout the circumference. The eustachian tube opening was packed with gelfoam and gelfoam bed was prepared over the middle ear. The dried graft was placed over the gelfoam bed and was laid throughout the circumference of the bone external canal. The tympanomeatal flap was reposed back and again supported with a layer of gelfoam.