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The American Academy of Otolaryngology-Head and Neck Surgery has updated its 2008 clinical practice guidelines on management of cerumen impaction.

The medical records of 438 patients who underwent myringoplasty followed up for a minimum of one year in the period of 1980 and 2015 were revised. Examination under otomicroscope was done of the ear to be operated. This was carried out with a speculum under the operating microscope to be reliably asses the tympanic membrane, site of perforation, to rule out any other pathology and assess the status of ossicular chain. All the patients submitted primary myringoplasty surgery were operated under postauricular, endaural and transcanal approach with overlay, underlay and inlay methods. In the study the patients were divided into three groups depending upon the technique utilized to repair the tympanic membrane. When we compared overlay technique group with underlay technique group, it was observed that overlay technique was no statistically significant difference between these three groups in term of age wise distribution, gender wise distribution, duration of disease and cause of disease, due to matching at the time of selection. In this study the outcome in terms of graft uptake rate was slight better in the overlay technique (94%) as compared to the underlay technique (86.2%), though the difference was statistically insignificant, P>0.05. Patients selection may have had a role in the high success rate in the present study as patients presenting with middle ear pathology were excluded. The complications rate in the present study was quite low, no case in inlay group, three cases of graft lateralization in underlay group, and 19 cases in overlay group. In this study, better results were achieved with overlay technique may probably be due to less surgical manipulation and faster healing process.

Abstracts Useful tips in ear surgery (V767) ID: 767.1 Learning Objectives: Introduction: Reconstruction of anterior or subtotal tympanic membrane perforation is challenging.

The diagnosis of congenital cholesteatoma was based on previous history that excluded tympanic membrane perforation, otorreha, or otologic procedure, an intact tympanic membrane on otomicroscopic examination and a identified cholesteatoma at the time of surgical procedures (tympanotomy, atticotomy, tympanomastoidectomy).

The posterior and anterior annulus are detached extending the anterior annulus 90 degrees anterior to the short process of the malleus, maintaining the stability of the tympanic membrane in the umbus.

The eardrum separates the external ear from the middle ear and it is responsible to convert the acoustical energy into mechanical energy. It is divided by pars tensa and pars flaccida. The aim of this work is to analyze the susceptibility of the four quadrants of the pars tensa under negative pressure, to different lamina propria fibers distribution. The development of associated ear pathology, in particular the formation of retraction pockets, is also evaluated. To analyze these effects, a computational biomechanical model of the tympano-ossicular chain was constructed using computerized tomography images and based on the finite element method. Three fibers distributions in the eardrum middle layer were compared: case 1 (eardrum with a circular band of fibers surrounding all quadrants equally), case 2 (eardrum with a circular band of fibers that decreases in thickness in posterior quadrants), case 3 (eardrum without circular fibers in the posterior/superior quadrant). A static analysis was performed by applying approximately 3000Pa in the eardrum. The pars tensa of the eardrum was divided in four quadrants and the displacement of a central point of each quadrant analyzed. The largest displacements of the eardrum were obtained for the eardrum without circular fibers in the posterior/superior quadrant.

Harvie et al present five things to know about traumatic tympanic membrane perforations (TMPs). TMPs typically present as sudden otalgia, hearing loss and bloody otorrhea in the context of a causative mechanism. Ear canal instrumentation accounts for approximately 60% of ear-related injuries (most commonly from cotton-tipped applicators).Diving or water sports are also well-recognized causes. Additionally, absence of tympanic membrane mobility on pneumatic otoscopy or conductive hearing loss on tuning fork examination (tuning fork pressed on forehead heard more loudly in the affected ear) can help establish the diagnosis.

In children younger than 3 years, rates of recurrent acute otitis media did not differ significantly following tympanostomy tubes or medical treatment.

Objective. The aim of this study is to evaluate the results of inlay butterfly tympanoplasty technique in large central tympanic membrane perforations.Methods. The files of the patients who underwent inlay butterfly cartilage tympanoplasty for large central tympanic membrane perforations were reviewed. Patients were followed with otoscopy and audiometry. Preoperative and postoperative pure-tone audiometry results were calculated and analyzed to evaluate the hearing gain. The grafting procedure was considered successful if no perforations were observed during postoperative microscopic or endoscopic evaluation during the follow-up period. Results. Twenty-nine patients with large central tympanic membrane perforation who were operated by inlay butterfly tympanoplasty technique were included in the study. Twenty-one (72.4%) ears were operated with endoscope and 8 (27.6%) under microscope. The mean duration of surgery was 30.5±3.77 minutes. The mean follow-up time was 69.6±21.6 (range; 24-112 weeks). Graft take rate was 89.7% (26/29).Conclusion. Inlay butterfly cartilage tympanoplasty is a minimal invasive and effective technique for repairing large central tympanic membrane perforations.