Description: Two randomized clinical trials evaluated hyaluronic acid gel (HAG) as an adjunct in middle ear surgery: as a sealing material in primary stapedotomy (150 ears, HAG vs fat) and as middle ear/external canal packing in tympanoplasty for large or subtotal perforations (488 ears, HAG vs absorbable gelatin sponge). In stapedotomy, HAG provided ABG closure ≤20 dB comparable to fat, with more ears achieving ABG ≤10 dB and no sensorineural safety signal. In tympanoplasty, 2.5% HAG significantly improved graft success while maintaining equivalent AAO-HNS hearing outcomes.

Outcome Objectives: After this session, attendees will be able to:

- Analyze randomized evidence for HAG versus traditional sealing/packing materials in middle ear surgery.
- Compare graft and hearing outcomes using standardized AAO-HNS reporting criteria.
- Recognize indications, contraindications, and safety considerations for HAG application.
- Implement practical techniques for using HAG as stapedotomy sealant and tympanoplasty packing.

Structure of the session: Didactic lecture with brief literature review, presentation of trial methodology and key results, operative images/video illustrating HAG use, and interactive case-based discussion, followed by audience Q&A on integrating HAG into routine otologic practice.

4 - Background (Key References)

1. Faramarzi M, Faramarzi A, Roosta S, et al. Hyaluronic Acid Gel as Middle Ear and External Auditory Canal Packing Material in Tympanoplasty. Otolaryngol Head Neck Surg. 2023
2. Faramarzi M, Roosta S, Aminpour S. Comparing Gelfoam vs Fat as a Sealing Material in Stapedotomy: A Prospective Double-Blind RCT. Clin Otolaryngol. 2019.
3. Faramarzi M, Roosta S, Faramarzi A, Asadi MA. Comparison of Hearing Outcomes in Stapedotomy with Fat and Hyaluronic Acid Gel as a Sealing Material. Eur Arch Otorhinolaryngol. 2021.
4. Faramarzi M, Kaboodkhani R, Roosta S, Azarpira N, Shishegar M, Bahranifard H. Application of amniotic membrane for covering mastoid cavity in canal wall down mastoidectomy. Laryngoscope. 2019;129(6):1453-1457.
5. Faramarzi M, Kaboodkhani R, Faramarzi A, Roosta S, Erfanizadeh M, Hosseinialhashemi M. Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy. Laryngoscope Investig Otolaryngol. 2021;6(5):1188-1195.

1. Description

Canal wall–down mastoidectomy (CWDM) often leaves troublesome cavities. This session synthesizes my prospective and retrospective clinical experience with four obliteration strategies in large CWDM defects: allogenic cancellous bone allograft, butterfly silicone block, amniotic membrane covering of a musculoperiosteal flap, and temporalis fascia. Using standardized outcomes—time to complete epithelialization, granulation/otorrhea, revision rate, graft success, and AAO-HNS hearing metrics—I will present how each material performs in different anatomic and revision scenarios, and how these data informed a simple, stepwise algorithm for selecting the optimal obliteration material while preserving a dry, stable ear and functional hearing.

2. Outcome Objectives

After the session, participants will be able to:

- Analyze indications, advantages, and limitations of bone allograft, silicone block, amniotic membrane, and temporalis fascia in CWDM mastoid obliteration.
- Compare epithelialization time, granulation/otorrhea, graft success, and hearing outcomes across the four techniques.
- Implement a practical, material-tailored algorithm for planning mastoid obliteration and external auditory canal reconstruction in everyday otologic practice.

Background – Key References

1- Faramarzi M, Kaboodkhani R, Faramarzi A, Roosta S, Erfanizadeh M, Hosseinialhashemi M. Mastoid obliteration and external auditory canal reconstruction with silicone block in canal wall down mastoidectomy. Laryngoscope Investig Otolaryngol. 2021;6(5):1188-1195.

2- Faramarzi M, Kaboodkhani R, Roosta S, Azarpira N, Shishegar M, Bahranifard H. Application of amniotic membrane for covering mastoid cavity in canal wall down mastoidectomy. Laryngoscope. 2019;129(6):1453-1457.

3- Faramarzi M, Atashi S, Edalatkhah M, Roosta S. The effect of anterior tab flap technique on graft success rate in large tympanic membrane perforation. Eur Arch Otorhinolaryngol. 2021;278(6):1765-1772.

4- Faramarzi M, Shishegar M, Kazemi T, Tavakolpour Saleh H, Roosta S. The effect of applying amniotic membrane on post-tonsillectomy pain and bleeding. Eur Arch Otorhinolaryngol. 2021;278(2):485-492.

5-Faramarzi M, Roosta S. Incidence of Facial Nerve Canal Dehiscence in Primary and Revision Cholesteatoma Surgery. Indian J Otolaryngol Head Neck Surg. 2017;69(3):300-306.

VEMP use has been developed during last 20 years. Yet, criteria for diagnosis of several patologies does not include their results. ¿Can we think about vestibular dysfunction only affecting gravitational receptors?

¿Can we evaluate hydrops affecting only vestibular receptors?

The Lecture aims to reflection on these topics, and shows why these studies should be part of ENT daily practice.

Main topics: use of vemps in deaf people, use of vemps in chronic dizziness, use of vemps to diagnose endolymphatic hydrops.