OBJECTIVETo compare the outcome and success of repair of uncomplicated tympanic membrane perforations with myringoplasty alone and when combined with mastoidectomy.METHODSA prospective study where 40 patients with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited during the period of June 2013 to December 2013 from the outpatient clinic of Otorhinolaryngology department, Faculty of medicine, Cairo University. Patients were managed medically and after dryness of their perforations they were operated upon. Twenty patients underwent simple myringoplasty alone and 20 patients underwent myringoplasty with cortical mastoidectomy. Underlay technique with temporalis fascia was done for all patients. Follow-up period was at least 3 months.RESULTSHearing improvement was comparable in both groups. There was no significant difference in graft uptake between the myringoplasty alone group (70%) and cortical mastoidectomy group (80%) (P = 0.7). There was no significant difference in ear dryness between the myringoplasty alone group (75%) and cortical mastoidectomy group (90%) (P = 0.4).CONCLUSIONMastoidectomy performed in non-cholesteatomatous CSOM in this study gives no statistically significant benefit over simple myringoplasty as regards graft success rate and dryness of the middle ear with comparable hearing outcome.

In spite of development of curved instrument, a reaching hidden area in the maxillary sinus (MS) is still problematic. Prelacrimal recess (PLR) is a concavity in the medial, anterosuperior part of the MS. It is located in front of the eminence of the lacrimal passages on the medial sinus wall ( Fig. 1) (Hosemann W et. al 2003). Good visualization is provided for complete excision of the lesion, from the viewpoint of minimal invasion, a drawback still exists in both external and intranasal surgical procedures. Compromise of the inferior turbinate (IT) and nasolacrimal duct (NLD) is often unavoidable (Brors D, et. al 1999).The aim of the study was to assess the role of the intranasal prelacrimal recess approach (PLRA) in complete removal of anterior maxillary lesions.This was a prospective study in which 20 patients were recruited between July 2013 and September 2014 from the Otorhinolaryngology outpatient clinic, kasr Al-Ainy hospital , Cairo University.Patients with anterior maxillary sinus (MS) lesions underwent endoscopic sinus surgery and had their lesions removed through the maxillary ostium. The PLRA was then performed to assess the presence of any anterior maxillary remnants, which were then removed. The operation was performed under general hypotensive anaesthesia, in supine head-up position. The nasal cavity was decongested and the middle meatus lesion was removed. Uncinectomy was performed and the MS ostium identified, which was then widened posteroinferiorly and also anteriorly using backbiting forceps while ensuring that the nasolacrimal duct (NLD) was not injured. After complete removal of the sinus lesion using different angled nasal endoscopes, when cannot completely remove the maxillary sinus lesion, the PLRA was performed. The incisionThe incision site was infiltrated with 1% lidocaine (xylocaine) with 1: 100 000 epinephrine solution. A curved mucosal incision was made on the lateral wall of the nasal cavity between the anterior aspect of the IT and the posterior end of the nasal vestibule, so that the depth of the incision reached the underlying bone (Fig.1). Mucoperiosteal elevationUsing a chisel, the mucoperiosteum was lifted posteriorly until the attachment of inferior turbinate (IT) to the lateral nasal wall and then the bony attachment of IT were disconnected (Fig. 2). Bone removal Bone removal was achieved using a gauch and hammer and a high-speed electric drill, the anterior bony portion of the medial wall of the MS (parts of the frontal process of the maxilla) was chiseled off, as this part forms the medial part of the prelacrimal recess (Fig. 3). Inferior turbinate-nasolacrimal duct flap medialization:-Chiseling the bone posteriorly exposed the NLD and then the IT-NLD flap was formed. It was pushed medially and medial mucosal wall of the MS was exposed (Fig. 4). Widening the prelacrimal recess:-The anteromedial bony wall of maxillary sinus was partially removed according to the extent of maxillary sinus pneumatization or the location of lesion (Fig 5). At this step we assessed if there...

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Background Endoscopic myringoplasty allows full visualization of the external ear canal, tympanic membrane, and middle ear without the need to reposition the patient’s head. The endoscope allows accessing hidden areas and structures not properly viewed by the microscope such as sinus tympani, facial recess, and hypotympanum. It also provides sharp, magnified image and shortens the duration of the surgery. The postoperative pain and morbidity are reduced and hence the hospital stay. The aim of this work was to evaluate the efficacy of the endoscopic-assisted permeatal transperforation “push-through” myringoplasty by assessing the graft take rate and hearing results. Our study included twenty patients (14 females and 6 males) with chronic suppurative otitis media without cholesteatoma that underwent endoscopic-assisted permeatal transperforation myringoplasty. Results The case was considered '”successful'” if there was complete healing of the tympanic membrane and improvement of hearing. Graft uptake success rates were 85% with P-value 0.132. Average air-bone gap (A-B gap) preoperative was 18.20 dB; average A-B gap 1-month postoperative was 7.75 dB. Conclusion Endoscopic transcanal myringoplasty provided sharp, magnified visualization and operability as it avoids retroauricular skin incision and minimizes surgical procedures to expose hidden areas. There is less bleeding, a shorter operating time, less postoperative morbidity, and minimal postoperative care.

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