INTRODUCTIONMyringoplasty is a surgical procedure which is confined to the drum head without manipulation of the ossicles or middle ear. Tympanoplasty is the surgical procedure which includes the manipulation of tympanic membrane and eradication of disease from the middle ear if present, if it is done in conjunction with manipulation of the ossicles it is known as tympanoossiculoplasty. Surgery that includes manipulation of mastoid along with tympanoplasty is known as tympanomastoidectomy. The development of tympanoplasty techniques led by incidental and inspirational contribution from surgeons all over the world. Specialized instruments like the ocular magnifying loops and the operating microscope opened up a new dimension to otology surgery. The newest technique of performing tympanoplasty is the endoscopic tympanoplasty. Initially endoscopes were used for diagnostic and teaching purpose of tympanic membrane and ear canal. Mer and colleagues introduced middle ear endoscopy in 1967.1 From then, endoscopes are increasingly used for various middle ear surgeries. In recent years, many surgeons have adopted it for middle ear surgery as opposed to microscope assisted ear surgery. Transcanal endoscopic approaches of middle ear provide wide angled view for inspecting the anatomy of the middle ear and redefining of the ossicles, which allows a better understanding of the ligaments and folds of the middle ear and help to understand the physiology of different spaces.2 The aim of otology surgeons at ABSTRACTBackground: Aim of the study was to evaluate the merits and demerits of endoscopic tympanoplasty compared to conventional microscopic tympanoplasty.Methods: This prospective comparative study was carried out between October 2015 to September 2016 in our otolaryngology department, for a period of 12 months. Total of 40 patients who fit into inclusion criteria, underwent endoscopic tympanoplasty under local anaesthesia with sedation. All laboratory preoperative testing was done; hearing evaluation was done with audiometry. Postoperative follow up was done at 2 nd and 3 rd month's period, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded. Results: Out of 40 patients, 16 (40%) were males, and 24 (60%) were females, there were 21 (52.5%) cases had moderate perforation, 15 (37.5%) cases had large perforation and 4 (10%) cases had subtotal perforation. Average time taken was of around 1hour and 30minutes, range was (70-140min.). All patients were evaluated for graft status, hearing gain and cosmetic results. Out of 40 patients, 35 (87.5%) patients had successful graft uptake, 2 (5%) patients had graft infection and 3 (7.5%) patients had residual perforation seen postoperatively. Conclusions: Use of endoscope not only serves as a great teaching tool, but also helps to visualize the middle ear anatomy and pathology intraoperatively with minimal soft tissue manipulation better cosmesis and reduced postoperative morbi...

<p class="abstract"><strong>Background:</strong> To compare the efficacy between fat graft (FG) and temporalis fascia (TF) graft in tympanic membrane perforations larger than 4mm size or involvement of &gt;25% of tympanic membrane.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out during December 2015 to January 2016, for a period of 13months at our Otolaryngology Department. All study patients, who fit into inclusion and exclusion criteria, were divided into two groups according to the type of graft material taken. In group- 1temporalis fascia (TF) graft was taken while in group- 2 fat graft (FG) was taken. An evaluation of hearing was done with full Audiometric and Eustaschian tube function testing. All laboratory preoperative testing was done. Postoperative follow up was done at 2^nd, 3^rd and 5^th month’s period and sos, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded and compared with preoperative PTA records in both groups.  </p><p class="abstract"><strong>Results:</strong> In TF group total 24 (80%) patients had graft uptake, 4 (13.3%) patients had residual perforation and 2 (6.6%) patients had graft failure due to postoperative infection. In FG group total 16 (53.3%) patients had graft uptake, 6 (20%) patients had graft medialised and necrosed, 6 (20%) patients had residual perforation and 2 (6.6%) patient had graft rejection due to postoperative infection. Graft uptake rate in group 1 was 80% while in group 2 was 53.3%. Mean preoperative ABG in TF group was 25±17 dB and mean postoperative ABG was 10±02 dB, in fat graft technique mean preoperative ABG was 25±13 dB and mean postoperative ABG was 16±15 dB. Fat graft technique is simple, quick and minimally invasive. It doesn’t require middle ear manipulation.</p><p><strong>Conclusions:</strong> There is no ideal material for tympanic membrane repair but for moderate to large perforation temporalis fascia graft is better than fat graft in terms of healing and hearing outcomes but considering morbidity fat gives less morbidity. </p>

<p class="abstract"><strong>Background:</strong> In the present study, an attempt was made to study the effectiveness of fat graft material and the improvement in hearing following fat myringoplasty in small central perforations of pars tensa.</p><p class="abstract"><strong>Methods:</strong> This prospective study was carried out in our tertiary centre between October 2014 to October 2015 in 38 patients selected randomly who attended our ENT OPD. Patients with tubotympanic type of chronic suppurative otitis media CSOM (TT), with dry small central perforation involving less than 25% of tympanic membrane (TM) were included. Patients with ossicular fixation or disruption with air bone gap (ABG) &gt;40dB were excluded. All procedures were performed under local anesthesia (LA). Fat graft was harvested from ear lobule and was placed through endomeatal microscopic approach after freshening perforation margin. All patients were followed up to 5months postoperative period and graft status and audiological assessment was made.  </p><p class="abstract"><strong>Results:</strong> In 86.8% cases (33 patients) graft was taken up while in 13.2% cases (5 patients) graft was not taken up. Mean pre-operative air conduction in right/left ear was 28.5±7.6/27.1±8.5 and post-operative was 24.9±5.3/23.4±6.9 dB respectively. Similarly, it was seen that mean pre-operative air bone gap in right/left ear was 17.6±7.2/17.0±7.4 and post-operative was 14.0±5.3/13.2±6 dB respectively.</p><strong>Conclusions:</strong> It is a very safe, simpler procedure and in this we don’t disturb the annulus so the chance of lateralization or medialization of graft is nil. During fat myringoplasty the angle of tympanic membrane and anterior recess is maintained in natural position and we don’t disturb acoustics, so fat myringoplasty is an excellent option especially for small perforation.

Post-auricular incisions used for ear surgeries have their distinct advantages and disadvantages. Numbness in post-auricular region or over pinna is a symptom encountered in many patients following surgery via postauricular incision. We performed this study to investigate this phenomenon of aural numbness in terms of frequency and severity. Design: Prospective study. Setting: This study was conducted in our hospital from 1st December 2015 to 30th November 2016 for a period of 1 year. The period of analysis was 1 month. Subjects: All patients undergoing surgery via post-auricular incision were included in the study. Methods: All the subjects were subjected to touch and pain sensory testing and also symptoms were recorded with the help of visual analog scale. The mean subjective Visual analog scale (VAS) value had significantly reduced after the surgery and it gradually improved over a period of about 6 months when it became near normal. Sensory testing revealed loss of touch and pain sensation in about 67% of patients following the surgery. The sensation recovered over a variable period of time, with about 95% of patients having normal touch and pain sensation 6 months after the surgery. Majority of patients treated with postaural incision develop sensory loss which is likely to recover in 3-6 months. Till that time patients should be counselled properly and appropriate measures should be taken to avoid any complications of sensory loss.

Xeroderma pigmentosum (XP) is genetic autosomal recessive disorder with photosensitivity on exposure to sun and also presents with various malignancies such as squamous cell carcinoma, basal cell carcinoma, and malignant melanoma. A 22-year-old female visited our outpatient clinic with 18 months history of pigmented nodule on her nose. She was diagnosed with XP since she was 2 years old. Physical examination revealed a waxy, blackish-brown nodule on her nose. Incisional biopsy was performed. The histological findings revealed multiple, palisaded basophilic tumor masses surrounded by prominent infiltrating lymphocytes confirming our clinical diagnosis. She was advised sun protection with the use of protective clothing and glasses. XP leads to chances of various malignancies. Early diagnosis, proper clinical examination, histopathological examination for the diagnosis of condition is must to come to proper diagnosis. Instructions to the patients to take proper protection from sun and wearing protective clothing must be given.