R A JI V GA N DH I UNIVER S IT Y O F HE A LT H SC I EN C ES , KAR N A TAK A B A N G A LORE A NNEXURE – II PROF O RMA FOR REGIS T R A TION OF SUBJEC T S FOR DISSERT A TION

Name of the candidate and : DR. SHIBANI V. ANCHAN 1. Address DEPT. OF ENT (In block letters) MAHADEVAPPA RAMPURE MEDICAL COLLEGE, GULBARGA - 585105

Permanent Address : DR. SHIBANI V. ANCHAN, SAIKRIPA, NEAR HALEANGADI BUS STAND, HALEANGADI POST , MANGALORE - 574146 2. Name of the Institution : H.K.E. SOCIETY’S MAHADEVAPPA RAMPURE MEDICAL COLLEGE, GULBARGA – 585105 3. Course of study and subjects : M.S .ENT 4. Date of admission to the : 31st May 2007 course

5. Title of Topic : AUDIOMETRIC EVALUATION OF TYMPANOPLASTY FOR HEARING IMPROVEMENT 6. Brief Resume of the Intended work 6.1 Need for the study:

In early centuries, ear infection with complication was a life threatening condition. The introduction of antibiotics and use of operative microscope in surgical field were revolutionary advances in control of disease.

Tympanoplasty is procedure to eradicate disease in middle ear and to reconstruct the hearing mechanism with or without Tympanic membrane grafting. This operation can be combined with either an intact canal wall or a canal wall down mastoidectomy to eradicate disease from the mastoid area. 6.2 Review of Literature

Amdee et al showed a 100% perforation repair rate and A-B gap closure to within 6DB, regardless of tympanplasty type, in 52 patietns with short – term followup. They used artilage strips to reconstruct tympanic membrane.1 IN a study of 1000 cartilage tympanoplasties, high risk peforation was an indication for use of cartilage in a third of cases and successful membrane closure was seen in more than 95% of which 60% were children (<18 years). 2 Duckert et al reported impressive hearing results and perforation closure rates by using perichondrial cartilage composite tympanic autografts in conjugation with TORPs and PORPs (Total and partial ossicular reconstruction prostheses). He achieve 10dB (A-B) gap closure in 73% of PORP and 70% of TORP type 3 tympanoplasties. 3

In 1983, Jackson et al standardized a reasonable expectation of hearing restoration after TORP reconstruction to within 30 dB air bone gap in 85% of patients and within 20 dB in 50%. For PORP reconstruction, they established that 70% of patients should achieve 20 dB closure. 4

Milweski showed closure to within 30 dB in 79% of all type 3 Tympanoplasty. 5

Gotay – Rodriguez and Schuknedt were able to achieve a 30 dB post operative (A-B) gap in 59% of 72 ears treated by open mastoidectomy and use of autologous temporalis fascia to create round window baffle and small split skin graft to cover the exteriorized mobile foot plate (Type IV tympanoplasty mastoidectomy).6

6.3 Objectives of the study

To determine the hearing improvement in tympanoplasty by pre- operative and postoperative audiometric evaluation after 1 month and 3 months and 6 months of tympanoplasty.

7. Materials and Methods 7.1 Source of Data:

Patients in ENT OPD at Basaveshwar Teaching and General Hospital, Gulbarga from 2007 to 2009. 7.2. Methods of collection of Data (Including sampling procedure, if any) Inclusion Criteria  Patients presenting with history and clinical feature of chronic suppurative otitis media with conductive deafness who undergo tympanoplasty with or without mastoidectomy using autologous temporalis fascia or cartilage graft or both. Exclusion criteria  Patients with sensorineural hearing loss.  Those who come with active discharge are treated until the ear becomes dry for period of 1 month before taking for surgery.  Patients with Eustachian tube occlusion  Biomaterials other than autografts excluded

Mode of selection: By simple random method.

Sample size: All patients in ENT OPD at Basaveshwar hospital from 2007 – 2009. 7.3. Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so, please describe briefly. Yes, Investigation and Intervention to be carried out as per requirement.

1. Otoscopy 2. Tuning fork tests – Rinnes, Webers, Absolute bone conduction test 3. Eustachian tube function test like valsalva maneuver, seigel speculum test 4. Routine blood and urine examination 5. Plain X-ray – bilateral mastoids 6. Aural examination under microscope 7. Pre-operative audiometry 8. Postoperative audiometry

7.4. Has ethical clearance been obtained from your institution incase of 7.3? Yes. Ethical clearance has been obtained from “Ethical clearance committee” of the Institution 8. List of references

1. Amdee RG, Mann WJ, Rechelmann H, cartilage palisade

typmpanoplasty, American Journal of Otolaryngology. 1989; 10: 447-450.

2. Dornhoffer J. Cartilage tympanoplasty; indications, technique and

outcomes in a 1,000 patient series, Laryngoscope 2003; 113(11):

1844-56.

3. Duckert LG, Muller J, Makielski KH et al. Composite autograft

“Shield” reconstruction of remanant tympanic membrane: American

Journal of Otolaryngology, 1995; 16: 21-26.

4. Jackson CG, Glasscock ME, Schwaber MK et al. Ossicular chain

reconstruction: The TORP and PORP in chronic ear disease,

Laryngoscope. 1983; 93: 981-98.

5. Milewski C. Composite graft tympanoplasty in treatment of ears with

advanced middle ear pathology, Laryngoscope. 1993; 103: 1352-1356.

6. Nicholas J, Frootko. Reconstruction of middle ear, chapter II Scott-

Brown’s otolaryngology volume 3, Otology, 6th edition, Butterworth –

Heinemann International Edition, Page 14.

7. Nicholas J, Frootko, Reconstruction of middle ear, Chapter II Scott

Brown’s Otolaryngology, Vol 3, Otology, 6th edition. Butterworth –

Heinemann International Edition. Page.No.19-24.

8. Shrestha S, Sinha BK, Hearing results after myringoplasty Kathmandu

University Medical Journal. 2006; 4(4): Issue 16, 455-459. 9. Signature of Candidate

10. Remarks of Guide

Name and Designation of the 11. 11.1 (In block letters) DR. R.B.CHAPPARBANDI MS (ENT) Guide ASSOCIATE PROFESSOR DEPARTMENT OF ENT M.R. MEDICAL COLLEGE. GULBARGA

11.2 Signature

11.3 Co-guide (if any)

11.4 Signature

DR. MALLIKARJUN.REDDY MS.DLO(ENT) 11.5 Head of the Department PROFESSOR AND HEAD, DEPARTMENT OF ENT M.R. MEDICAL COLLEGE, GULBARGA

11.6 Signature

Remarks of the 12. 12.1 Chairman and Principal

12. 2 Signature