EDB is more effective than the traditional ESD in controlling the symptoms of Ménière's disease. It is a novel surgical technique with promising results for a complete treatment of Ménière's disease. There are no significant complications or adverse effect.

Our objectives were to review all reported staging systems of tympanic membrane (TM) retraction pockets (RP) and to report their reliability and utility to our daily clinical practice in terms of follow-up and decision making in the management of RP. We aim to propose a new management algorithm of TMRPs. We conducted a thorough research on Ovid Medline, Pubmed and Cochrane databases for English and French languages studies published between 1963 and 2012 on the retraction pocket. Studies were excluded if it were a short comments, photo clinical cases, experimental studies or round table articles. Cholesteatoma was not included in keywords, since it is considered as an advanced pathological entity with different staging and management approaches. We included 60 of 756 articles that met our inclusion criteria. Sadé and Berco proposed the first staging system of RP in 1976, while the last one was described by Borgstein et al. in 2007. From 1976 to 2007, 12 different staging systems have been described for tympanic membrane retractions. There are three broad categories of TMRPs: localized retractions of the pars tensa, generalized retractions of the pars tensa (atelectasis) and retraction of the pars flaccida. Most of the described staging systems are useful for following up the evolution of retractions over time. However, no consensus was found concerning the decision making in its management. In conclusion, proper management of TMRPs requires a reproducible, easily applicable staging system with low inter- and intra-observer variability. We propose a management algorithm that considers the functional handicap of the patient rather than the topographic description of the TM.

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We aim to compare the hyaluronic acid to fat graft myringoplasty (HAFGM) technique to a recently described modified-FGM (M-FGM) in the repair of tympanic membrane perforation (TMP). We also aim to evaluate the hearing level improvement postoperatively. We conducted a prospective study in an adult tertiary care center between 2012 and 2013. Adult patients presenting with simple TMP were operated on randomly using either HAFGM or M-FGM under local anesthesia in outpatients' settings. Success was considered when complete closure is achieved. Audiometric parameters were evaluated pre and postoperatively. Twenty-four patients were included in the study (HAFGM: 10 patients and M-FGM: 14 patients). Complete closure was achieved in 80 % in HAFGM vs 42.8 % in the M-FGM (p = 0.03). The study was abandoned due to the low success rate in first 14 patients of the M-FGM group. The pure tone audiometry was improved postoperatively in the HAFGM only. The study was aborted because of the unsatisfactory obtained results using the MFGM. It also shows the beneficial effect of hyaluronic acid application to FGM for a successful TMP repair.