Paraganglioma is the commonest middle ear tumor and the 2 nd most common temporal bone tumor after vestibular schwannoma. Different classification systems have been proposed based on the extension of the tumor. Diagnosis is based on both clinical and radiological features. CT is valuable in defining the extension of the lesion and excluding erosion of the jugular bony plate. Endoscopic excision of these tumors has been described in the early 2010s. We report a case of female patient 40-years-old with right tympanic paraganglioma extending to the protympanum and hypotympanum. Exclusive transcanal endoscopic excision was performed.

Objective: 1) To evaluate a novel system for regulating the chitosan-glycero-phosphate (CGP)-based hydrogel drug delivery to the inner ear. 2) To understand the distribution of gentamicin in the inner ear following CGP drug delivery with and without regulation.Method: Chitosanase, specifically targeting CGP, was identified and purified for its use as a CGP regulation system. In vitro and in vivo studies were conducted to evaluate the effect of the chitosanase on the inner ear drug delivery and distribution. GentamicinTexas Red (GTTR) was used for tracking the drug distribution.Results: Purified chitosanase was confirmed with Western blot. The in vitro study showed that the chitosanase-based regulation system effectively controlled the gentamicin releasing. The in vivo data concur with in vitro findings and demonstrated that the gentamicin concentration in the inner ear can be successfully regulated by applying the chitosanase. Moreover, the gentamicin inner ear distribution can also be regulated by changing its inner ear concentration. Conclusion:Our study suggests that the chitosanase-based regulation system can be effectively used for controlled inner ear drug delivery. This system has a potential to stop inner ear drug application when side effects or drug-related toxicities start to occur and should be used for safe drug application in the inner ear. Otology/NeurotologyRepair of Big Drum-Head Defect by Underlay Fascia and STSG Hamza E. Ahmed, MD (presenter)Objective: 1) Describe the technique of grafting total and near-total tympanic membrane perforations using underlay temporalisfascia graft augmented by split-thickness skin graft from the ear lobule. 2) Evaluate the procedure in terms of graft take, hearing outcomes, and complications.Method: This clinical study was conducted on 91 patients (93 perforations) having total (6) or near-total (87) tympanicmembrane perforation from January 2005 till December 2010 in a teaching university hospital. Myringoplasty utilizing temporalis-fascia graft underlay supported externally by splitthickness lobular-skin graft. Graft take, early and late PTA changes, and complications were evaluated.Results: Graft take was achieved in 86 out of 93 operations (92%), with 7 cases of graft failure (8%). PTA improvement was 16.3 dB at 3-month postoperative versus 15.5 dB at 1 year. Other complications noticed were prolonged graft swelling with discharge (3 cases), 2 of them ended by graft breakdown and the third improved. Bleeding from the jugular bulb during abrasion of middle-ear floor mucosa occurred twice, and in one of them bleeding stopped with surgicel. In the other extraluminal packing of the sigmoid sinus was necessary. The procedure was completed. No blunting or donor site complications were noticed. Conclusion:Large TM perforations can be managed successfully by underlay temporalis-fascia graft supported externally by STSG from the ear lobule laid in part over the deep meatal skin and in the other part over the graft. One can expect >90% graft take, >15 dB PTA improvemen...