Packing of tympanic cavity is generally considered an essential step in myringoplasty. However, each packing material comes with one or another side effect. The objective of this meta-analysis was to compare the results of Type 1 myringoplasty with or without packing. Pubmed, Cochrane database, Embase, Google Scholar, and clinicaltrials.gov were searched using \'tympanoplasty or myringoplasty and packing\' as the search query. All RCTs / quasi-RCTs comparing tympanoplasty Type 1 with packing (control) versus without packing (intervention) of tympanic cavity in the human population were included. For dichotomous and continuous outcomes, relative risks (RR) and mean differences (MD) were calculated with 95% confidence interval, respectively. Heterogeneity was assessed using I2 statistics. Publication bias was checked using funnel plot and Egger\'s test, if applicable. Quality of evidence was assessed for each outcome using GRADE approach. Eleven studies were deemed eligible. For graft uptake and functional success rate, RR of 1.01 and 1.05 were obtained, respectively, showing no significant differences between the intervention and control groups. At 1st and 3rd postoperative month, no-packing group showed 3.86 dB and 2.08 dB better air-bone gap (ABG) closure than the packing group, respectively. Also, intervention with no-packing was 9.28-minute shorter procedure. With RR 0.35, no-packing had significantly lesser postoperative aural fullness. Type 1 tympanoplasty performed with or without packing show comparable results in terms of graft uptake and functional success rate. However, if performed without packing, it takes shorter time, provides early hearing improvement and causes less aural fullness. Key Words: Tympanoplasty Type 1, Packing, Gelfoam, No-packing, Meta-analysis, Endoscopic myringoplasty.

BACKGROUND: This study aimed to explore the impacts of different middle-ear mucosal conditions on the outcomes of type I tympanoplasty.
METHODS: A retrospective analysis of 164 patients with chronic otitis media was carried out. The patients were divided into 4 groups according to their mucosal condition. Preoperative hearing levels and air-bone gap (ABG) before and after surgery were compared via the Kruskal‒Wallis H test. The chi-squared test and Fisher\'s exact test were used to assess the postoperative complications and impact factors of functional success.
RESULTS: Preoperatively, neither the air conduction nor bone conduction values differed significantly among groups with different mucosal conditions. All of the ABG closed dramatically after type I tympanoplasty (P < .05) regardless of the mucosal conditions. The functional success rates were lower when the intratympanic mucosa was moderately or severely edematous compared with mildly edematous or normal (P < .05). The disease course, perforation site, and perforation size, as well as the status of the opposite ear, were not related to the auditory functional outcome. The differences in postoperative reotorrhea and reperforation among the 4 groups were not statistically significant.
CONCLUSIONS: Preoperative hearing levels were not affected by middle-ear mucosal conditions. The functional success rate was influenced by mucosal conditions, but hearing levels were significantly enhanced after surgical intervention regardless of the mucosal status. Postoperative complications were not related to the mucosal conditions. Thus, type I tympanoplasty is adoptable for mucosal abnormalities when pharmacotherapy cannot result in a healthy tympanum.

OBJECTIVE: To evaluate the anatomic and functional outcomes of type1 tympanoplasty with endoscopic modified butterfly cartilage-perichondrium technique.
METHODS: In our modification, perichondrium was elevated circumferentially till the attached part of the composite graft was approximately same size and shape of the perforation, cartilage was trimmed based on the perforation but 0.5 mm larger. Cartilage portion of the graft was placed medial to the edge of the perforation, then perichondrium was rolled out and draped on the circumferential raw surface of remaining tympanic membrane around.
RESULTS: At 4 months postop, the anatomic integrity rate of the tympanic membrane perforation for small & medium sized perforation and large sized perforation group were 100 % and 94 % (p > 0.05). For the small & medium perforation group, the mean pre and 4 months postop ACs were 30 ± 8 dB and 18 ± 6.4 dB (p < 0.01). The mean pre and 4 months postop ABGs were 19 ± 11 dB and 9 ± 3 dB (p < 0.01). For the large perforation group, the mean pre and 4 months postop ACs were 43 ± 12.5 dB and 21.5 ± 7 dB (p < 0.01). The mean pre and 4 months postop ABGs were 34 ± 8.5 dB and 12.5 ± 6 dB (p < 0.01). The differences of mean 4 months postop ACs and mean 4 months postop ABGs between the two groups were not significant (p > 0.05).
CONCLUSIONS: Compared to the conventional inlay butterfly cartilage tympanoplasty technique, large or marginal perforations can be sealed more securely by this modification.

Objective:To analyze the surgical efficacy and safety of tympanoplasty with and without mastoidectomy for the treatment of active simple chronic suppurative otitis media（CSOM）, and to investigate whether mastoidectomy can be avoided in tympanoplasty for active CSOM. Methods:The clinical data of 55 patients（55 ears） with active CSOM were retrospectively analyzed. Based on the development of the mastoid process and the upper tympanic chamber, patients who met the criteria for wall-up mastoidectomy were classified as group A （30 patients）, and underwent tympanoplasty combined with wall-up mastoidectomy. Patients who did not meet the criteria for wall-up mastoidectomy were classified as group B（25 cases）, and underwent tympanoplasty with the opening of the middle and upper tympanic chambers and sinus drainage after partial removal of the shield plate bone. The survival rate of tympanic membrane grafts, hearing before and after surgery, and complications such as reperforation were compared between the two groups at 3 months postoperatively. Results:The overall postoperative tympanic membrane survival rate of patients with active CSOM was 96.4%（53/55）, including 96.7% in group A; 96.0% in group B. There was no significant difference in the tympanic membrane survival rate between the two groups（P>0.05）. The postoperative mean air-bone gap（ABG） was significantly reduced in both groups compared with the preoperative period, but there was no significant difference in ABG gain between the two groups（P>0.05）. No patients experienced serious adverse conditions such as peripheral facial paralysis, cerebrospinal fluid leakage, or sensorineural deafness after surgery. Conclusion:Microscopic tympanoplasty with patency of the middle and upper tympanic chambers and tympanic sinus drainage can be used to treat active simple chronic otitis media with satisfactory tympanic membrane viability and hearing improvement efficacy. This approach reduces patient trauma, prevents complications such as skin depressions in the mastoid area due to abrasion of the mastoid bone, and shortens the waiting time before surgery.
目的：分析鼓室成形术伴与不伴乳突切开治疗活动期单纯型慢性化脓性中耳炎（chronic suppurative otitis media，CSOM）的手术疗效及安全性，探讨在活动期CSOM鼓室成形术中是否可以避免开放乳突。 方法：回顾性分析55例（55耳）活动期CSOM患者的临床资料，根据患者乳突及上鼓室发育情况，将有条件完成完壁式乳突切开术的患者为A组（30例），行鼓室成形术联合完壁式乳突切开术。无条件完成完壁式乳突切开术的患者为B组（25例）采用去除部分盾板骨质后通畅中、上鼓室及鼓窦引流，同时完成鼓室成形术。比较2组患者术后3个月鼓膜移植成活率、手术前后的听力情况及再穿孔等并发症情况。 结果：活动期CSOM患者术后整体鼓膜成活率为96.4%（53/55），其中A组为96.7%；B组为96.0%，2组患者鼓膜成活率差异无统计学意义（P>0.05）。2组患者术后平均气骨导差值（ABG）较术前均有明显缩小，但2组患者ABG增益差异无统计学意义（P>0.05）。所有患者术后均无周围性面瘫、脑脊液漏、感音神经性聋等严重不良情况。 结论：显微镜下采用通畅中上鼓室、鼓窦引流后的鼓室成形术治疗CSOM可获得满意的鼓膜成活率和听力提高疗效。且减少患者的创伤，防止因磨除乳突骨质后发生乳突区皮肤凹陷等并发症，缩短手术前的等待时间。.

Objective:To investigate the changes in hearing threshold of the acquired primary cholesteatoma of the middle ear with different degrees of eustachian tube dysfunction after balloon eustachian tuboplasty. Methods:This retrospective study included forty cases with middle ear cholesteatoma and eustachian tube dysfunction who underwent open mastoidectomy + tympanoplasty + balloon eustachian tuboplasty were enrolled. All patients were admitted from November 2020 to April 2022. The preoperative eustachian tube score of 0-2 were defined as the lower group, and the scores of 3-5 were defined as the higher group. Pure tone audiometry was measured preoperatively and 1, 3, 6 and 12 months postoperatively. The average value of bone conduction threshold and air conduction threshold of 250-4 000 Hz were calculated, and the air-bone gap was calculated simultaneously. SPSS 25.0 was used for statistical analysis. P<0.05 was considered statistically significant. Results:In the lower group, the air conduction threshold and air-bone gap at 3 months postoperatively were significantly decreased in comparison with those preoperatively（P<0.05），as was the air-bone gap at 6 months postoperatively（P<0.05）. In the higher group, the air conduction threshold and air-bone gap were significantly decreased at 3, 6 and 12 months postoperatively（P<0.05）. Conclusion:The air conduction threshold and air-bone gap of patients with the acquired primary cholesteatoma of the middle ear and eustachian tube dysfunction were significantly decreased after eustachian tube balloon dilatation. Hearing improvement lasted longer in patients with slight eustachian tube dysfunction.
目的：探讨咽鼓管功能障碍程度不同的后天原发性中耳胆脂瘤患者行咽鼓管球囊扩张术后的听力变化情况。 方法：回顾性分析2020年11月至2022年4月行开放式乳突切开+鼓室成形+咽鼓管球囊扩张术的后天原发性中耳胆脂瘤伴咽鼓管功能障碍患者40例，术前咽鼓管评分为0～2分者为低分组，3～5分者为高分组。分别于术前、术后1、3、6及12个月测量患者纯音听阈，计算250～4 000 Hz骨导听阈、气导听阈平均值，并计算气骨导差。通过SPSS 25.0进行统计学分析，以P<0.05表示差异有统计学意义。 结果：低分组术后3个月时的气导听阈和气骨导差较术前降低（P<0.05），术后6个月的气骨导差较术前降低（P<0.05）。高分组术后3、6和12个月的气导听阈和气骨导差较术前降低（P<0.05）。 结论：后天原发性中耳胆脂瘤伴咽鼓管功能障碍患者行咽鼓管球囊扩张治疗后，气导听阈和气骨导差较术前明显改善，咽鼓管功能障碍程度较轻的患者听力改善维持时间更持久。.

OBJECTIVE: This study aimed to establish the minimal clinically important difference (MCID) and assess the responsiveness of the Chinese version of Zurich Chronic Middle Ear Inventory (ZCMEI-21-Chn).
METHODS: Prospective multicenter study.
METHODS: Four Chinese tertiary referral centers admitting patients nationwide.
METHODS: 230 adult patients with chronic otitis media (COM) undergoing tympanoplasty.
METHODS: Patients were required to complete the ZCMEI-21-Chn to measure health-related quality of life both preoperatively and postoperatively. An anchor-based method was used to determine the MCID of the derivative cohort by including the Global Rating of Change Questionnaire as an anchor. The generalizability and consistency with functional outcomes of the MCID estimates were externally examined in a validation cohort using a receiver operating characteristic curve analysis.
RESULTS: A total of 161 and 69 patients were included in the derivative and validation cohort. The mean preoperative and postoperative ZCMEI-21-Chn total scores were 28.4 (standard deviation [SD] 14.5) and 17.5 (SD 12.6). The mean change in ZCMEI-21-Chn score was 10.9 (SD 14.3, p < 0.001). The MCIDs of the ZCMEI-21-Chn for improvement and deterioration were estimated at 13 (SD 13.0) and -7 (SD 12.9), accordingly. For patients who have reported an improved health-related quality of life, a cutoff value of 15.6 dB HL for elevation of the air-conducted hearing threshold was noticed. However, change of clinical importance judged according to MCID and Japan Otological Society criteria disagreed with each other, notably with a Cohen\'s kappa ( κ ) of 0.14 ( p = 0.21) in the validation cohort.
CONCLUSIONS: This study is the first to establish the MCID of a COM-specific questionnaire in Chinese. For the COM population undergoing surgical intervention, MCID values of 13 for improvement and -7 for deterioration are recommended. The results were externally validated to be generalizable to nationwide usage, yet distinguishable from the audiological criteria. The availability of the MCID greatly adds to the clinical utility of the ZCMEI-21-Chn by enabling a clinically meaningful interpretation of its score changes.

Objective:To study the difference of postoperative efficacy between two-person three-hand ear endoscopy and microscopic tympanoplasty in patients with chronic suppurative otitis media, and to explore the advantages and disadvantages of two-person three-hand ear endoscopy. Methods:A retrospective study was conducted on 100 patients who underwent tympanoplasty in the Department of Otolaryngology and Head and Neck Surgery of Hunan People\'s Hospital from April 2019 to March 2023, and they were divided into 2 groups with 50 cases each according to random number table method. Among them, 50 cases underwent endoscopic tympanoplasty in two-person three-hand（group A） and 50 cases underwent routine microscopic tympanoplasty（group B）. The operation and postoperative conditions of the two groups were followed up. Results:In group A, the mean operation time was（65.78±18.21） min, the mean intraoperative blood loss was（12.94±4.46） mL, the postoperative pain score was（1.82±0.60） points, and the mean postoperative hospital stay was（2.76±0.72） d. The mean operation time of group B was（89.45±20.38） min, the mean intraoperative blood loss was（22.78±5.74） mL, the postoperative pain score was（2.98±0.85） points, and the mean postoperative hospital stay was（3.82±0.75） d, which with statistical significance between the two groups（P<0.05）. Hearing in both groups was significantly improved 6 months after surgery, and the difference was statistically significant before and after surgery（P<0.05）, but there was no significant difference between the two groups before surgery and 6 months after surgery（P>0.05）. There were 2 cases in group A（4%） and 1 case in group B（2%） complicated with tympanic cord injury during operation, and the difference was not statistically significant（P>0.05）. There were 47 cases of A group（94%） of one-time healing of tympanic membrane after operation, 48 cases（96%） of group B, and the difference was not statistically significant（P>0.05）. Conclusion:There is no significant difference in cure rate and hearing improvement between two-person three-hand ear endoscopic tympanoplasty and conventional microscope surgery, and the operation time is significantly shortened, the amount of blood loss is less, and the postoperative recovery is faster. It has the advantages of clear operating field, two-person three-hand operation, minimally invasive, and can reach the range of middle ear tympanic sinus and mastoid apex, and the surgical complications are seldom, which is worth promoting.
目的：研究双人三手操作耳内镜与显微镜下鼓室成形术对慢性化脓性中耳炎患者术后疗效的差异，探讨双人三手操作耳内镜的优势与不足。 方法：回顾性研究2019年4月—2023年3月在湖南省人民医院耳鼻咽喉头颈外科接受鼓室成形术的100例患者，根据随机数字表法将其分为2组，各50例。其中接受双人三手耳内镜下鼓室成形术50例（A组），行常规显微镜下鼓室成形术50例（B组），对2组患者的手术及术后情况进行随访。 结果：A组手术平均时间为（65.78±18.21） min、术中平均出血量为（12.94±4.46） mL、术后疼痛评分为（1.82±0.6）分、术后平均住院时间为（2.76±0.72） d；B组手术平均时间为（89.45±20.38） min、术中平均出血量为（22.78±5.74） mL、术后疼痛评分为（2.98±0.85）分、术后平均住院时间为（3.82±0.75） d，2组比较差异均有统计学意义（P<0.05）。2组患者术后6个月听力均有明显提高，术前、术后比较差异均有统计学意义（P<0.05），但术前、术后6个月2组间指标比较，差异均无统计学意义（P>0.05）。术中并发鼓索神经损伤A组2例（4%），B组1例（2%），差异无统计学意义（P>0.05）。A组术后鼓膜一次性愈合情况共47例（94%），B组48例（96%），差异无统计学意义（P>0.05）。 结论：双人三手操作耳内镜下鼓室成形术治愈率、听力改善情况与常规显微镜手术无明显差异，手术用时明显缩短、出血量更少、术后恢复更快，其具有术野清晰、双手操作、微创等优点，可覆盖中耳鼓窦及乳突范围，手术并发症低，值得推广。.

UNASSIGNED: Numerous studies have been conducted on the effect of the stapes superstructure after ossicular chain reconstruction, but the findings are not uniform.
UNASSIGNED: To compare the hearing outcomes of ossicular chain reconstruction with partial ossicular replacement prosthesis (PORP) or total ossicular replacement prosthesis (TORP) under otoendoscopy.
UNASSIGNED: The records of 111 patients diagnosed with chronic suppurative otitis media were retrospectively analyzed. These patients were divided into PORP group (n = 57) and TORP group (n = 54). They were further subdivided into subgroups PORP-a (with a malleus handle) and PORP-b (without a malleus handle), subgroups TORP-a and TORP-b. Pre- and postoperative audiometric results were analyzed.
UNASSIGNED: The mean postoperative air conduction hearing thresholds improvement, mean air-bone gap improvement, and the success rate of reconstruction were significantly higher in the PORP group than in the TORP group (p < .05). The mean postoperative air conduction hearing thresholds improvement and the success rate of reconstruction were significantly higher in the PORP-a group than in the TORP-a group (p < .05); and similar results were concluded in comparison of the PORP-b group and the TORP-b group.
UNASSIGNED: The stapes superstructure has an important positive effect on the postoperative outcome of endoscopic ossicular chain reconstruction.

Objective:To study the feasibility and efficacy of using a tympanic cartilage shaping device in endoscopic type Ⅰ tympanoplasty. Methods:A tympanic cartilage shaper was designed and manufactured by measuring tympanic membrane dimensions with HRCT imaging for cutting and shaping cartilage to repair the tympanic membrane. From August 2019 to October 2021, 66 patients（72 ears） with chronic suppurative otitis media in Xiangya Hospital underwent endoscopic type Ⅰ tympanoplasty with this tympanic cartilage shaping device, and were observed the tympanic membrane healing and hearing recovery effect after surgery. Postoperative follow-up ranged from 3-24 months, with an average of 9 months. The data were analyzed by the SPSS 26.0 software. Results:According to the imaging measurements, tympanic pars tensa width（8.60±0.20） mm, height（8.64±0.19） mm, design and manufacture a cylindrical cartilage shaping device with inner diameter 8.60 mm. After tympanoplasty, the healing rate of tympanic membrane was 100%; The average air-bone gap before surgery was（23.10±7.33） dB, then（14.30±6.40） dB 1 month after surgery, which were significant reduced compared with those before surgery. The average air-bone gap was（14.30±6.40） dB 3 month after surgery compared with 1 month after surgery, the difference was also statistically significant（t=6.630, P<0.05）. Conclusion:The tympanic membrane cartilage shaper shaping cartilage in endoscopic tympanoplasty is simple, stable and reliable, which can reduce the time of graft cartilage processing, improve the efficiency of surgery, and restore the tympanic membrane morphology and function in the postoperative period.
目的：研究运用鼓膜软骨塑形器塑形软骨在耳内镜下Ⅰ型鼓室成形术中的可行性和疗效。 方法：通过高分辨率CT（HRCT）影像学测量鼓膜尺寸设计制造一种鼓膜软骨塑形器，用于裁剪和塑形软骨以修补鼓膜。选取2019年8月-2021年10月中南大学湘雅医院耳鼻咽喉头颈外科66例（72耳）慢性化脓性中耳炎患者应用此软骨塑形器在耳内镜下完成Ⅰ型鼓室成形术，术后对鼓膜愈合情况、听力恢复效果等进行观察。术后随访3～24个月，平均9个月。采用SPSS 26.0软件对数据进行统计学分析。 结果：根据影像测量鼓膜紧张部宽为（8.60±0.20） mm、高为（8.64±0.19） mm，设计内径8.60 mm的圆筒状软骨塑形器。用鼓膜软骨塑形器塑形的软骨软骨膜复合物行鼓室成形术后，鼓膜愈合率为100%；术前平均气骨导差为（23.10±7.33） dB，术后1个月平均气骨导差缩小为（16.80±6.10） dB，差异有统计学意义（t=7.831，P<0.05）；术后3个月平均气骨导差为（14.30±6.40） dB较术后1个月进一步缩小，差异亦有统计学意义（t=6.630，P<0.05）。 结论：鼓膜软骨塑形器塑形软骨在耳内镜下鼓室成形术中应用简便、稳定、可靠，可以减少移植物软骨处理时间，提高手术效率，术后鼓膜形态和功能恢复好。.

Objective:To investigate the surgical outcomes and safety of the follower arm endoscope holder in assisting type Ⅰ tympanoplasty. Methods:The clinical data of 16 patients who underwent type Ⅰ tympanoplasty at the Department of Otorhinolaryngology, Peking Union Medical College Hospital, from November 2022 to September 2023 were retrospectively analyzed, among which 8 cases were operated by traditional otoscopy and 8 cases were operated by supported endoscopy.The surgical procedure was analyzed and the completion of supported endoscopic operation was observed, while the duration of the operation, the time consumed by the main steps, the frequency of wiping the lenses, the perioperative complications, and the improvement of the postoperative hearing were recorded and statistically analyzed. Results:Supporting endoscopic technology achieved real-time suction of bleeding, simultaneous traction and separation of tissues, precise removal of calcified spots on the inner side of the eardrum, trimming of the external auditory canal flap, stable separation of the handle of the malleus and the eardrum, and tensioned repositioning of the skin-cartilage flap. The average duration of surgery, time for external auditory canal flap preparation, and time for repositioning the skin-cartilage flap were reduced in the supporting endoscopic surgery group compared to the control group. The average lens wiping frequency was significantly lower in the supporting endoscopic surgery group compared to the control group. There was no statistically significant difference in postoperative hearing improvement between the two groups, and no infections or the need for secondary surgery due to eardrum re-perforation occurred postoperatively. Conclusion:Supported endoscopy technology realizes the need for endoscopic two-handed operation and convenient switching between one and two hands, accomplishes many operations that cannot be done by traditional endoscopic surgery, solves the problems of previous intraoperative one-handed operation and image instability, shortens the average operation time compared with traditional otoscopic surgery, and decreases the frequency of intraoperative wiping of the lens significantly compared with traditional otoscopic surgery, which is potentially worthwhile in terms of shortening the learning curve.
目的：探讨支撑内镜技术辅助Ⅰ型鼓室成形术的手术效果及其安全性。 方法：回顾性分析2022年11月—2023年9月在北京协和医院耳鼻咽喉科接受Ⅰ型鼓室成形术的16例患者的临床资料，其中传统耳内镜手术组8例，支撑内镜手术组8例，分析手术流程，观察支撑内镜下操作的完成情况，同时记录手术持续时间、主要步骤耗时、擦拭镜头频率、围术期并发症及术后听力改善情况，并进行统计学分析。 结果：支撑内镜技术实现了耳内镜手术中实时吸除渗血，一手牵拉组织时另一手进行分离，精细去除鼓膜内侧钙化斑，修剪外耳道皮瓣，稳定分离锤骨柄和鼓膜，有张力地复位皮肤软骨膜瓣等操作。支撑内镜组的平均手术持续时间、外耳道皮瓣制作时间和皮肤软骨膜瓣复位时间较对照组减少，平均擦拭镜头频率较对照组明显下降。2组患者术后听力改善情况差异无统计学意义，术后均未发生感染或是因鼓膜再穿孔需要进行二次手术。 结论：支撑内镜技术实现了内镜下双手操作及单双手便捷切换的需求，完成了许多传统内镜手术无法完成的操作，解决了既往术中单手操作及图像不稳定等问题，平均手术时间较传统耳内镜手术缩短，术中擦拭镜头频率较传统耳内镜手术明显下降，具有缩短学习曲线的潜在价值。.