Purpose: Otitis media is a global middle ear disease with health and economic burden especially in Africa and other developing nations. Chronic suppurative otitis media is an important cause of preventable hearing loss which warrants attention; particularly in the developing world, as it may have important socio-economic implications over and above patients’ quality of life. When presenting with an infected ear due to chronic suppurative otitis media, one may have impaired hearing and a perforated eardrum/s. Thus a type 1 tympanoplasty, i.e. myringoplasty operation is indicated to seal the eardrum. A review of literature demonstrates that extensive evidence exists on the success rate and efficacy of myringoplasty surgery in terms of audiological improvement worldwide; however there is paucity of evidence within the developing world context. Numerous studies published are from developed countries which are vastly different to developing countries. Thus this study aimed to explore audiological function in a group of adults following myringoplasty within a developing country context. Participants: Participant files from the last six years were obtained from the Ear, Nose and Throat (ENT) and Audiology departments at two academic hospitals in Gauteng, Johannesburg. The total sample comprised of 52 participant files consisting of, 20 males (38%) and 32 females (62%), with ages ranging from 18-63years with a mean age of 39.9 years. All 52 participant files could not be included in all the analysis due to missing biographical and/or audiological information in some of the files. Design: This study was conducted using a retrospective record review quantitative research design; where specific objectives of the study were explored. These included; a description and comparison of hearing function pre and post myringoplasty and an exploration of the possible influence of factors such as HIV/AIDS and type of surgical technique on hearing outcome post-surgery. Data analysis: Data was analysed using both descriptive and inferential statistics. Inferential statistics in the form of Kolmogorov-Smirnov two sample test and two-tailed paired (dependent) t-test were used to establish statistical significance levels to determine where statistically significant changes occurred pre and post-operatively and to establish if these changes were dependent on specific variables (HIV status and type of surgical technique). Results: Clinically overall hearing improved post-operatively in terms of tympanometry, pure tone audiometry (air-conduction and bone-conduction testing) and speech reception threshold testing. The predictors for improved hearing outcome post-operatively were; HIV negative status and butterfly cartilage inlay surgery as a surgical technique adopted. Although clinically hearing outcomes improved post-operatively at all air-conduction frequencies; statistically the changes in air-conduction hearing function were only statistically significant at specific frequencies. HIV/AIDS appeared to have an influence on hearing outcome post surgery when investigating clinically but these changes were only statistically significant mainly in HIV negative patients at three air-conduction frequencies. No statistically significant differences were found in mean change in hearing function in both HIV negative and positive patients at all bone-conduction thresholds. Although the type of surgical technique (specifically the butterfly cartilage inlay surgery) had an influence on hearing outcome post-surgery; these changes in air-conduction hearing function in patients who underwent this surgical technique were only statistically significant at specific frequencies. For patients who underwent fascia underlay, no statistically significant changes were found postoperatively. Conclusion: Current findings offer valuable baseline evidence on hearing outcome pre and post myringoplasty within this developing country context. This evidence can serve as a baseline for future research in the South African population. The study yielded relevant information regarding variables affecting the outcome of myringoplasty surgery in a South African context which is essential in the management of patients from an audiological and surgical perspective.

Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirement for the Degree of Masters of Medicine in Otorhinolaryngology Johannesburg October 2017 / AIM: This study aimed to assess the anatomical and functional success rate of Butterfly Cartilage Inlay Graft myringoplasties done at Chris Hani Baragwanath Academic Hospital using an oto-endoscope. Size of perforation was assessed as a possible predictor of success. METHODS: The study comprised of a retrospective review of all records from the ENT Department at Chris Hani Baragwanath Academic Hospital of all patients who underwent BCIG myringoplasty from January 2009 to December 2013. 85 of the 160 patients who had BCIG’s at CHBAH met the inclusion criteria for this study. Data was collected on a data collection sheet and analysed using standard statistical methods. RESULTS: 85 patients were included in the study of ages 5 years – 67 years with a mean age (SD) of 19,2 years (16,3). 61% were children (<13 years), 39% adults (14 – 49 years) and only 6% were >50 years. There were 30 (35%) Female patients and 55 (65%) Male patients. The data presented in this study show an anatomical success rate of 90,6% for Butterfly Cartilage Inlay Grafts at Chris Hani Baragwanath Academic Hospital. The anatomical success rate of this study is equal to the success rates reported in the literature for the same procedure. 87% of patients experienced hearing improvement post operatively. The average hearing improvement in this study post Butterfly Cartilage Inlay Graft is 15dB. Finally, perforation size does not influence both anatomical and functional success rates in this study. CONCLUSION: Endoscopic BCIGs performed at Chris Hani Baragwanath Academic Hospital, for small, medium and large perforations, show anatomical and functional success rates similar to those reported in the literature, performed with both microscope and endoscope. Size of perforation is not a predictor of anatomical and functional success for this procedure. / MT2018

O efeito do fator de crescimento epitelial e da pentoxifilina, isolados ou em associação, foi avaliado em perfurações subagudas de membranas timpânicas de chinchilas, comparando-se ao grupo controle. O fator de crescimento epitelial auxiliou o processo de cicatrização de perfurações subagudas de membranas timpânicas, o que não se observou com a pentoxifilina. O percentual de cicatrização das perfurações foi de 30,3%, 3,6%, 16,5% e 8,7% nos grupos fator de crescimento epitelial, pentoxifilina, fator de crescimento epitelial com pentoxifilina e controle, respectivamente / The effect of epidermal growth factor and pentoxifylline, in combination or alone, was evaluated in chinchillas with subacute tympanic membrane perforations, and compared with a control group. Epidermal growth factor helped in the healing of subacute tympanic membrane perforations, but the same was not observed for pentoxifylline. The healing rate of perforations was 30.3%, 3.6%, 16.5% and 8.7% for the following groups: epidermal growth factor, pentoxifylline, epidermal growth factor with pentoxifylline and untreated controls, respectively

O efeito do fator de crescimento epitelial e da pentoxifilina, isolados ou em associação, foi avaliado em perfurações subagudas de membranas timpânicas de chinchilas, comparando-se ao grupo controle. O fator de crescimento epitelial auxiliou o processo de cicatrização de perfurações subagudas de membranas timpânicas, o que não se observou com a pentoxifilina. O percentual de cicatrização das perfurações foi de 30,3%, 3,6%, 16,5% e 8,7% nos grupos fator de crescimento epitelial, pentoxifilina, fator de crescimento epitelial com pentoxifilina e controle, respectivamente / The effect of epidermal growth factor and pentoxifylline, in combination or alone, was evaluated in chinchillas with subacute tympanic membrane perforations, and compared with a control group. Epidermal growth factor helped in the healing of subacute tympanic membrane perforations, but the same was not observed for pentoxifylline. The healing rate of perforations was 30.3%, 3.6%, 16.5% and 8.7% for the following groups: epidermal growth factor, pentoxifylline, epidermal growth factor with pentoxifylline and untreated controls, respectively