Annexure II proforma for registration of subjects for dissertation



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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALURU, KARNATAKA.
ANNEXURE - II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION



1.

NAME OF THE CANDIDATE AND ADDRESS





DR. AJAY KUMAR

PG IN ENT

NAVODAYA MEDICAL COLLEGE HOSPITAL & RESEARCH CENTRE,RAICHUR - 584103.



2.

Name of the institution



NAVODAYA MEDICAL COLLEGE RAICHUR-584103



3.


Course of the study and subject


M.S.( ENT)


4.


Date of admission to the course


14 /06/2013


5.



Title of the topic

A STUDY OF EFFICACY OF ENDOSCOPIC MYRINGOPLASTY IN IMPROVING CONDUCTIVE HEARING LOSS IN DRY CHRONIC SUPPURATIVE OTITIS MEDIA(CSOM)”





6.


Brief resume of intended work:
6.1 NEED FOR THE STUDY:

Myringoplasty (Type I tympanoplasty) is one of the commonest operations performed on the middle ear. Traditionally over the decades, tympanoplasty has been done using an operating microscope. Despite the continuous technical advancements, the basic

optical principles of the microscope and their limitations have remained the same over

the last three decades. Till the last decade endoscopes have been mainly used for

diagnostic and photographic purposes. The use of rigid endoscope for myringoplasy have a significant advantage, as it is simple to use, not only for examination,

but also for the repair of tympanic membrane perforation with magnified vision. Further, it provides an all-round vision to the surgeon, who can rotate the angled endoscope to visualize the areas which are relatively difficult to visualize with traditional microscope.Considering the above facts this study is being undertaken to demonstrate the usefulness of endoscope in myringoplasty.

Hence this is a study to assess improvement in conductive hearing loss in an inactive chronic suppurative otitis media(csom) patients after endoscopic assisted myringoplasty.

Review of Literature:

El-Guindy described an endoscope transcanal myringoplasty using a perichondrium graft with good results for adult patients.Overall graft take rate after 6 month followup was 91.7% and air bone gap was closed to less than10dB in 83.3%. He stated that otoendoscope could replace the operating microscope.(1)

A study conducted by Raj A, Mehar R on endoscopic transcanal myringoplasty, showed that graft uptake is 90% in endoscopic method and 85% in microscopic method but there was no significant differences between the gain in the air bone gap in either group.Study was done on 40 patients.(2)

Study conducted by Harugop AS, Mudhol RS, Godhi A, on a comparative study of endoscopy assisted myringoplasty and microscopy assisted myringoplasty concluded that surgery with endoscope has several advantages and few disadvantages.Surgical outcome of endoscopy assisted myringoplasty was comparable to the conventional microscopic assisted myringoplasty but in terms of cosmesis post-operative recovery the patient in endoscope group had better result(3)

Karhuketo operated on thirty ears with different sized perforation of the tympanic membrane with the aid of rigid otoendoscopes. The overall success rate for perforation closure was 80%. The post-operative air bone gap was less than 10 dB in 90% of the ears. It was concluded that tympanoscope assisted myringoplasty is areliable and simple procedure with the benefit of minimal trauma to healthy tissue.(4)

Yadav SPS et al carried out endoscopic assisted myringoplasty in 50 patients aged between 18 to 45 years with rigid 1.7mm otoendoscope and shown 80 % graft uptake and hearing improvement.(5)

Usami and colleagues applied endoscope assisted myringoplasty technique to patients,in whom due to curved external auditory canal, the margin of the perforation of the tympanic membrane was not visible with an operating microscope.Out of 22 endoscope assisted myringoplasties, perforation closure was obtained in 18(81.8%) cases with regard to hearing outcome, this technique provided satisfactory results with improvement in air-bone. gaps after surgery.(6)

Karhuketo et al visualized middle ear structures with otoendoscopes of and 0°, 30° and 90° angles of view. With the aid of endoscopes the medial surface of the tympanic membrane and the whole tympanic cavity and status of the ossicles can be visualized without raising the tympanomeatal.(7)

Fabinyi B;Klug C studied, a minimally invasive technique for endoscopic middle ear disease and concluded that middle ear endoscopy should be considered a useful adjunctive or alternative method to microscopic surgical exploration for middle ear pathology.This minimally invasive technique provides excellent visualization for viewing the surgical micromorphology and pathological findings of the middle ear.The selected patients underwent middle ear endoscopy using a transtympanic approach.(8)

Endoscopic transtympanic tympanoplasty with columella and endoscopic transtympanic tympanoplasty with interposition were performed in seven and two patients, respectively.The average hearing level before the operation was 59 dB.After the endoscopic transtympanic tympanoplasty, the average improved to the level of 27 dB, with an average air-bone gap of 11 dB.(9)

Somers et al studied the histology of 30 human tympanic membrane specimens with a central perforation and they found mucoepithelial junction was located medially to the rim of perforation in 30% of the cases.The surgeon can inspect the medial surface of tympanic membrane by elevation of tympanomeatal flap created by skin incision in the ear canal.(10)
OBJECTIVES OF THE STUDY:

To assess improvement in conductive hearing loss in patients of dry tubotympanic type of chronic suppurative otitis media after endoscope assisted myringoplasty.

.






Materials and methods:

7.1 Source of data:

All patients attending the out-patient department of ENT, NAVODAYA MEDICAL COLLEGE HOSPITAL & RESEARCH CENTRE , RAICHUR who had satisfied the inclusion criteria mentioned below during the study period of 2 years from september 2013 to september 2015 were included in the study to collect data.


7.2 METHOD OF COLLECTION OF DATA:

SAMPLE SIZE: Data collected from 50 cases of dry tubo tympanic type of

CSOM.


STUDY DESIGN AND SAMPLING
This will be a prospective study.All the eligible patients who satisfied the inclusion criteria mentioned below are included in the study. Otoscopic examination and tuning fork tests, and pre-operative pure tone audiometry (PTA) will be done to know the perforation,degree of hearing loss, air bone gap.Pre-operative routine investigations will be done. Post-operative PTA done to assess outcomes such as improvement in hearing, air bone gap closure are measured.

Appropriate statistical test will be used to analyse the data.




INCLUSION CRITERIA:

      1. Patients of dry tubotympanic type of CSOM

      2. Age : beween 11yrs and 50 yrs

      3. Intact & mobile ossicular chain


EXCLUSION CRITERIA:

      1. Active Ear discharge within last one month prior to surgery

      2. Age less than 11 yrs and more than 50 yrs

      3. Patients with mixed or sensorineural hearing loss

      4. Patients with ossicular erosion



7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR

INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR

OTHER HUMANS OR ANIMALS? IF SO DESCRIBE BRIEFLY.

Yes.


  • Routine pre-op blood investigations such as Hb,BT,CT,HIV, HBS Ag

  • Pre-operative PTA

  • Post-operative PTA

  • X- ray mastoid

  • Chest X- ray PA view

  • Rigid endoscopy


7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3?

- YES


8.


List of references:

  1. El guidy A. Endoscopic transcanal myringoplasty. J Laryngol Otol. 1992;106:493-5.

  2. Raj A, Meher R Endoscopic transcanal myringoplasty-a study Indian Journal of Otolaryngology and Head and Neck surgery.2001;53(1): 47-49.

  3. Harugop A S, Mudhol R S, Godhi A:Comparative study of endoscope assisted myringoplasty and micrsoscope assisted myringoplasty Indian Journal of Otolaryngology and Head & Neck Surgery.2008;60(4):298-302.

  4. Karhuketo TS, Ilomäki JH, Puhakka HJ Tympanoscope-Assisted Myringoplasty. ORL 2001;63:353–58.

  5. Yadav SPS, Aggarwal N, julaha M, Goel M. Endoscope assisted Myringoplasty.Singapore Med J 2009; 50(5):510-12.

  6. Usami S, lijima N, Fujita S, Takumi Y. Endoscopic – Assisted Myringoplasty.ORL 2001;63:287-90.

  7. Karhuketo TS, Laippala PJ, Puhakka HJ. Endoscopy and otomicroscopy in the estimation of middle ear structure. Acta otolaryngol(stockh). 1997;117:585-9B.

  8. Fabinyi;C. Klug , a minimally invasive technique for endoscopic middle ear surgery.European Archives of Oto-Rhino-Laryngology.Eur Arch Otorhinolaryngol 1997;254:S53-S54.

  9. Kakehata S,Futai K,Sasaki A,Shinkawa H.Endoscopic transtympanic tympanoplasty in the treatment of conductive hearing loss: early results. Otol Neurotol. 2006 Jan;27(1):14-9.

  10. Somers TH, houben V, Goovaerts G, Goovaerts PJ, Affeciers FE. Histology of the perforated tympanic membrane and its mucoepithelial junction. ClinOtolaryngol. 1997;22:162-6.





9.


SIGNATURE OF THE CANDIDATE





10.


REMARKS OF THE GUIDE

This study helps us to understand better, the intricacies of endoscopic myringoplasty in improving the conductive hearing loss in dry CSOM and as our hospital has all the facilities this study can be taken up..




11.


11.1 NAME AND DESIGNATION OF THE GUIDE


DR.M.RAJASHEKAR MBBS,DLO,MS

PROFESSOR,

DEPARTMENT OF ENT, HEAD and NECK SURGERY,

NAVODAYA MEDICAL COLLEGE HOSPITAL & RESEARCH CENTRE,RAICHUR.



11.2 SIGNATURE




11.3 HEAD OF THE DEPARTMENT


DR.MALLIKARJUN REDDYMBBS,DLO,MS

PROFESSOR AND HEAD,

DEPARTMENT OF ENT, HEAD and NECK SURGERY,

NAVODAYA MEDICAL COLLEGE HOSPITAL & RESEARCH CENTRE, RAICHUR.



11.4 SIGNATURE



12.


12.1 REMARKS OF THE CHAIRMAN AND THE PRINCIPAL





12.2 SIGNATURE





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