Allan Ho

Background: Tympanoplasty is a common procedure performed by Otolaryngologists. Many types of autologous grafts have been used with variations of techniques with varying results. This is the first systematic review of the literature and meta-analysis with the aim to evaluate the effectiveness of one of the techniques which is gaining popularity, the palisade cartilage tympanoplasty. PubMed, EMBASE, and Cochrane databases were searched for “palisade”, “cartilage”, “tympanoplasty”, “perforation” and their synonyms. Main body of In total, 199 articles reporting results of palisade cartilage tympanoplasty were identified. Five articles satisfied the following inclusion criteria: adult patients, minimum 6 months follow-up, hearing and surgical outcomes reported. Studies with patients undergoing combined mastoidectomy, ossicular chain reconstruction, and/or other middle ear surgery were excluded. Perforation closure, rate of complications, and post-operative pure-tone average change were extracted for pooled analysis. Study failure and complication proportions that were used to generate odds ratios were pooled. Fixed effects and random effects weightings were generated. The resulting pooled odds ratios are reported. Palisade cartilage tympanoplasty has an overall take rate of 96% at beyond 6 months and has similar odds of complications compared to temporalis fascia (OR 0.89, 95% CI 0.62, 1.30). The air-bone gap closure is statistically similar to reported results from temporalis fascia tympanoplasty. Conclusions: Cartilage palisade tympanoplasty offers excellent graft take rates and good postoperative hearing outcomes for perforations of various sizes and for both primary and revision cases. This technique has predictable, long-term results with low complication rates, similar to temporalis fascia tympanoplasty.

Objective: To present a case of spontaneous, bilateral hemotympanum secondary to chemotherapy-induced thrombocytopenia. Methods: Case report and review of the literature. Results: Bilateral spontaneous hemotympanum is an exceedingly rare event. We present the first case of nontraumatic bilateral hemotympanum secondary to chemotherapy-induced thrombocytopenia in a patient with acute myelogenous leukemia. The patient presented with a 7-day history of progressive bilateral hearing loss and a platelet count of 10 × 10⁹/L after receiving his first dose of induction chemotherapy. A small, left-sided subdural hematoma was present in this patient though no extra-aural sources of bleeding to explain the bilateral hemotympanum were identified. Conclusion: Full resolution of symptoms was achieved with conservative management.

The Otogram is an automated computer-assisted audiometer that allows patients to self-administer audiometry for their pure-tone audiogram. There has been no research published in a peer-reviewed journal, validating its use in an otology outpatient clinic. We therefore proposed to investigate and compare the inter-rater and intrarater accuracy and reliability of audiologists and of the Otogram in an English-speaking British population. Prospective nonrandomized validation study. Secondary otolaryngology center and otology outpatient clinic. Forty-eight NHS patients referred to an otology outpatient clinic. Each patient had 2 pure-tone audiograms. Hearing thresholds in decibels hearing level were ascertained by fully trained British audiologists and by the Otogram. Using the weighted kappa statistic, the level of agreement in air-conduction (kappa = 0.965) and bone-conduction (kappa = 0.927) thresholds between the audiologist and the Otogram on the same patient was equivalent to the inter-rater level of agreement between pairs of audiologists. Approximately 94% of air-conduction thresholds and 91% of bone-conduction thresholds measured by the Otogram fell within 10 dB of thresholds measured by an audiologist. Intrarater comparisons between audiologists were very good for air-conduction (kappa = 0.978) and bone-conduction (kappa = 0.964). The intrarater level of agreement between repeated Otogram thresholds was just as good for air-conduction (kappa = 0.974) and bone-conduction (kappa = 0.945) thresholds. The Otogram is just as reliable as audiologists at determining hearing thresholds. We recommend that the Otogram can be safely used in a controlled clinical setting supervised by audiologists.