Objective Underlay Tympanoplasty with superiorly based circumferential fl ap for dry subtotal perforations. Results It was noted that 89% of the cases were in the age group of 11 to 40 years, while one case was of 7 years of age and 9% of cases were between the age of 41-50. 50% of the cases had dry ear for less than 3 months while 75% of cases had dry ear for less than 1 year. Graft take rate was 97% with completely healed tympanic membrane. Rejection of the graft was observed in 2% of the cases. Hearing gain of 10-30dB was achieved in 95% of the cases. 7% of the cases suffered minor complications like otitis media with effusion (2%) retraction (2%) and lateralization (1%). Study DesignConclusion Duration for which ear has been dry did not affect the results. 49% of cases had dry ear for less than 3 months, with good graft take up rate and hearing gain.Pneumatization of mastoids, had a direct relationship with, post operative hearing gain, which ranged from 10-30 dB, in 95% of the cases. We observed, 97% graft take rate. Rejection of the graft was found in only 2% of the cases. 97% of the graft take rate and good hearing gain in our study can be correlated with expertise technique to deal with subtotal perforations.

Decannulating a patient on a tracheostomy is a procedure that has to be dealt with vigilantly. This study evaluated both external and telescopic/bronchoscopic findings at the peristomal level of subjects being considered for decannulation. The patients did not undergo any intervention after above observations and before attempting decannulation. Thereafter peristomal findings and their contribution towards failure to decannulate were correlated. Thirty subjects were studied prospectively, of whom 21 (70 %) demonstrated peristomal complications including granulation tissue, ulceration, mucopurulent discharge, suprastomal granulations, suprastomal collapse and suprastomal flap. Complications were more common in the younger age group (p = 0.007) as well as in tracheostomies of longer duration with mean duration [20 months (p = 0.045). However there was no statistically significant correlation between the success of decannulation and various peristomal findings. Therefore the success of decannulation in a particular case cannot always be correctly predicted by peristomal assessment.