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Mandour MF, Elsheikh MN, Amer M, Elzayat S, Barbara M, Covelli E, Elfarargy HH, Tomoum M. The impact of adding platelet-rich plasma during fat graft myringoplasty for managing medium-sized tympanic membrane perforations: A prospective randomized case-control study. Am J Otolaryngol 2023; 44:103755. [PMID: 36580741 DOI: 10.1016/j.amjoto.2022.103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/15/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to evaluate the effect of adding platelet-rich plasma (PRP) during FGM to close medium-sized TM perforations. METHODS This prospective randomized case-control study was conducted from February 2017 to March 2022. We included 320 patients with a medium-sized TM perforation with inactive mucosal otitis media. Transcanal FGM managed all patients under general or local anesthesia according to the patient preference. According to PRP, patients were divided into two groups: the first with PRP (170 patients) and the other without PRP (150 patients). We evaluated the closure rate of both groups one month, six months, and one year after the surgery. Also, we assessed the audiological performance before and one year after the operation for the patients with a successful closure. RESULTS The closure rate was 87.6 % in the first group and 72.7 % in the second group, with a statistically significant difference between both groups as the P-value, was 0.001. Successful closure of the ABG to <10 dB occurred in 95.3 % of group A and 90.8 % of group B without a statistically significant difference between both groups (P-value = 0.163). CONCLUSIONS This prospective comparative study on a relatively large number of patients revealed that FGM effectively closed medium-sized TM perforations. It also significantly improved postoperative audiological performance in both groups. Adding PRP during the FGM enhanced the closure success and the healing process without recorded complications. We recommend using the PRP in the routine FGM for closing medium-sized TM perforations.
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Affiliation(s)
- Mahmoud F Mandour
- Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed N Elsheikh
- Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohamed Amer
- Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Maurizio Barbara
- Department of Neuroscience, Mental Health and Sensory Organs, Sant Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Italy
| | - Edoardo Covelli
- Department of Neuroscience, Mental Health and Sensory Organs, Sant Andrea University Hospital, Faculty of Medicine and Psychology, Sapienza University, Italy
| | - Haitham H Elfarargy
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, Egypt.
| | - Mohamed Tomoum
- Otorhinolaryngology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
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Review of Transcanal Endoscopic Ear Surgery (TEES) and Bioengineering for Pediatric Otologic Surgery. CURRENT OTORHINOLARYNGOLOGY REPORTS 2022. [DOI: 10.1007/s40136-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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3
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Aleemardani M, Bagher Z, Farhadi M, Chahsetareh H, Najafi R, Eftekhari B, Seifalian A. Can Tissue Engineering Bring Hope to the Development of Human Tympanic Membrane? TISSUE ENGINEERING PART B-REVIEWS 2021; 27:572-589. [PMID: 33164696 DOI: 10.1089/ten.teb.2020.0176] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The tympanic membrane (TM), more commonly known as the eardrum, consists of a thin layer of tissue in the human ear that receives sound vibrations from outside of the body and transmits them to the auditory ossicles. The TM perforations (TMPs) are a common ontological condition, which in some cases can result in permanent hearing loss. Despite the spontaneous healing capacity of the TM to regenerate in the majority of cases of acute perforation, chronic perforations require surgical interventions. However, the disadvantages of the surgical procedure include infection, anesthetic risks, and high failure of graft patency. The tissue engineering strategy, which includes the applications of a three-dimensional (3D) scaffold, cells, and biomolecules or a combination of them for the closure of chronic perforation, has been considered as an emerging treatment. Using this approach, emerging products are currently under development to regenerate the TM structure and its properties. This research aimed to highlight the problems with the current methods of TMP treatment, and critically evaluate the tissue engineering approaches, which may overcome these drawbacks. The focus of this review is on recent literature to critically discuss the emerging advanced materials used as a 3D scaffold in the development of a TM with cellular engineering, biomolecules, cells, and the fabrications of the TM and its pathway to the clinical application. In this review, we discuss the properties of TM and the advantages and disadvantages of the current clinical products for repair and replacement of the TM. Furthermore, we provide an overview of the in vitro and preclinical studies of emerging products over the past 5 years. The results of recent preclinical studies suggest that the tissue engineering field holds significant promise.
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Affiliation(s)
- Mina Aleemardani
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Zohreh Bagher
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- ENT and Head & Neck Research Centre and Department, The Five Senses Institute, Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Hadi Chahsetareh
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Roghayeh Najafi
- Department of Life Science Engineering, Faculty of New Science and Technologies, University of Tehran, Tehran, Iran
| | - Behnaz Eftekhari
- Biomedical Engineering Department, Amirkabir University of Technology, Tehran, Iran
| | - Alexander Seifalian
- Nanotechnology and Regenerative Medicine Commercialisation Centre (NanoRegMed Ltd.), London BioScience Innovation Centre, London, United Kingdom
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Han JS, Han JJ, Park JM, Seo JH, Park KH. The Long-Term Stability of Fat-Graft Myringoplasty in the Closure of Tympanic Membrane Perforations and Hearing Restoration. ORL J Otorhinolaryngol Relat Spec 2020; 83:85-92. [PMID: 33341797 DOI: 10.1159/000512084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS This study was conducted to evaluate the long-term stability of fat-graft myringoplasty (FGM) for chronic tympanic membrane perforations, analyzing the perforation closure rate and re-gained hearing outcome with respect to the size and location of the perforations. METHODS Between August 2007 and June 2018, a total of 193 patients who underwent FGM due to chronic tympanic membrane perforation at a tertiary referral center were enrolled and analyzed. RESULTS The mean follow-up was 14.6 months (range 6-39). The complete perforation closure rate after FGM was 89.6%, with no statistical difference among the perforation size groups. The mean postoperative air-bone gap (ABG) was 11.0 dB and mean ABG improvement was 4.9 dB. CONCLUSION Our FGM technique had a favorable tympanic closure rate for small to large perforations, and yielded relatively good hearing improvement in the mid-size perforation cases over long-term follow-up periods. According to the topographic evaluation of FGM, this procedure resulted in a reliable perforation closure rate and audiological results regardless of the perforation site.
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Affiliation(s)
- Jae Sang Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Ju Han
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Mee Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung, Republic of Korea
| | - Jae-Hyun Seo
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyoung Ho Park
- Department of Otolaryngology-Head and Neck Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
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5
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Liu Y. Which element plays important role for the effect of myringoplasty between platelet rich plasma, hyaluronic acid and fat graft? Am J Otolaryngol 2020; 41:102386. [PMID: 31928739 DOI: 10.1016/j.amjoto.2020.102386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/02/2020] [Indexed: 11/25/2022]
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Can Fat-plug Myringoplasty Be a Good Alternative to Formal Myringoplasty? A Systematic Review and Meta-analysis. Otol Neurotol 2019. [PMID: 29533328 DOI: 10.1097/mao.0000000000001732] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study reviewed available literature to evaluate the success rate of fat myringoplasty compared with methods using other graft materials and suggests proper indications for this procedure. DATA SOURCES Studies reporting the success rate of fat myringoplasty were systematically reviewed by searching the MEDLINE, PubMed, and Embase databases for studies published from database inception to 2017. STUDY SELECTION The following terms were used for the literature search: ("Fat" OR "Adipose") and ("Myringoplasty" OR "Tympanoplasty"). DATA EXTRACTION Eight case series reported the data of perforation size and audiologic results. The success rate varied according to the perforation size with a cutoff value of 3 to 5 mm in length or 30% of the total tympanic membrane area. The success rate in anterior perforation was lower than that in other sites, ranging from 76.7 and 85.2% to 84.5 and 91.7%, respectively. The meta-analysis was performed on 10 articles. The overall success rate in fat myringoplasty and paper patch technique was not significantly different, while the success rate of fat myringoplasty was lower than that for the conventional myringoplasty technique using fascia or perichondrium (OR 0.63, 95% CI 0.49-0.80). Hyaluronic acid showed a significantly higher success rate than fat myringoplasty (90.1% versus 69.9%) (OR 0.20, 95% CI 0.09-0.46). CONCLUSIONS The success rate of fat myringoplasty may be associated with the perforation site and size. The success rate of fat myringoplasty was equivalent to that of the paper patch but inferior to a conventional method using perichondrium or fascia.
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Chen SL, Yang SW. Factors affecting the treatment outcomes of myringoplasty in patients with small tympanic membrane perforations. Eur Arch Otorhinolaryngol 2019; 276:3005-3012. [PMID: 31377902 DOI: 10.1007/s00405-019-05583-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Factors affecting the outcomes of myringoplasty have been widely discussed but remain controversial. In this study, we retrospectively analyzed the factors associated with the outcomes of myringoplasty treating small tympanic membrane perforations (defined as those involving less than 30% of the whole eardrum area) in patients with a history of chronic otitis media. METHODS The clinical demographic data, preoperative pure tone audiometry, surgical procedures, and surgical outcomes of patients with small tympanic perforations were analyzed statistically. Overlay myringoplasty was performed in 24 ears (45.27%); Gelfoam® plugs were placed in 29 ears (54.73%). Univariate and multivariate tests among demographic, surgical procedure-related, hearing test-related factors were performed. RESULTS A total of 53 patients (22 males and 31 females) were enrolled (mean age 54.84 ± 15.51 years). Fourteen patients (26.41%) had the habit of cigarette smoking, 8 (15.09%) had diabetes mellitus, 20 (37.73%) had a past history of chronic otitis media, 5 (9.43%) had a history of grommet insertion, 5 (9.43%) had received radiotherapy in the head and neck region, and 1 (1.88%) had microtia. The success rate for overlay myringoplasty using Silastic® sheets was 54.16%; the success rate for Gelfoam® plugs was 54.16%. On univariate analysis, smoking, older age, and the mean air conduction and bone conduction hearing levels significantly affected the surgical outcomes. Cigarette smoking was the only independent (negative) prognostic factor of surgical success on multivariate analysis (OR = 0.1614, 95% CI: 0.0336-0.7762, p = 0.0228). CONCLUSION As for surgical repair for the small tympanic membrane perforations with a history of chronic otitis media, age, cigarette smoking, mean air conduction threshold, and mean bone conduction threshold were associated with surgical outcomes; cigarette smoking was the independent predictive prognostic factor for the surgical outcomes.
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Affiliation(s)
- Shih-Lung Chen
- Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Yang
- School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Otolaryngology and Head and Neck Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
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Shiomi Y, Shiomi Y. Surgical outcomes of myringoplasty using platelet-rich plasma and evaluation of the outcome-associated factors. Auris Nasus Larynx 2019; 47:191-197. [PMID: 31320230 DOI: 10.1016/j.anl.2019.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 06/06/2019] [Accepted: 06/20/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Tympanic membrane perforations must be closed with surgery; however, most surgical procedures are considerably invasive in nature. The aim of this study was to evaluate the outcomes of minimally invasive myringoplasty using platelet-rich plasma (PRP) and an atelocollagen sponge for closure of chronic tympanic membrane perforations, as well as to identify the factors affecting the surgical outcome. METHODS The records of 118 patients who underwent surgical closure of chronic tympanic membrane perforation at an ear-nose-throat clinic were reviewed retrospectively. After removing the margin of the perforation via a transcanal approach under local anesthesia, an atelocollagen sponge injected with PRP was inserted into the perforation as a scaffold. If the size of the perforation decreased after the surgery, the same surgical procedure was repeated. The success rate of closure after the last surgery was evaluated in terms of the size of the perforation. In addition, the relationships of the success rate with the cause and duration of perforation and patient age were also examined. RESULTS The perforation was closed after initial or repeat surgeries in 95.8% (68/71) of cases with small-sized perforations, 80.0% (32/40) of cases with middle-sized perforations, and 85.7% (6/7) of cases with large-sized perforations. Multiple surgeries (up to four times) were required for middle- and large-sized perforations, and even for some small-sized perforations. The number of re-operations required for closure significantly increased with increase in the size of the perforation (Kruskal-Wallis test, p<0.01). The cause and duration of perforation were not predictors of the surgical outcome. However, patient age was a significant predictor of the surgical outcome; patients older than 80years had a significantly worse success rate than younger patients (Fisher's exact test, p<0.01). CONCLUSION Minimally invasive myringoplasty using PRP has a satisfactory success rate even for large-sized tympanic membrane perforations. PRP is autologous and its use is non-toxic and safe. Although informed consent from the patient is necessary for the repetition of the surgery and for patients older than 80years, this technique appears to be a promising office-based procedure for closure of chronic tympanic membrane perforations.
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Affiliation(s)
- Yousaku Shiomi
- Shiomi ENT Clinic, 8-15 Yakushi-cho, Nishinomiya, Hyogo, Japan.
| | - Yoshiko Shiomi
- Shiomi ENT Clinic, 8-15 Yakushi-cho, Nishinomiya, Hyogo, Japan.
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Iso-Mustajärvi M, Dietz A, Löppönen H. Myringoplasty Quality Control Is Necessary: Comparison of Surgical Results of Two Consecutive Series in A Single Institution. J Int Adv Otol 2018; 14:135-139. [PMID: 29764787 DOI: 10.5152/iao.2018.4276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate and compare myringoplasty results from two different consecutive series conducted at the Kuopio University Hospital during a four-decade period. MATERIALS AND METHODS We reviewed 315 patients (a total of 338 ears) who underwent myringoplasty at Kuopio University Hospital between the years 1986 and 2012. The results from this series were compared with those form a previously published series of 404 patients who underwent myringoplasty between 1970 and 1985 at the same institution. RESULTS Myringoplasty was considered to be successful whenever the tympanic membrane remained closed without atelectasis. The results were analyzed at the 1- and 3-year follow-up. The overall success rate after 1 year was 82.8% compared with 88% in the previous series. The success rate after 3 years was 87.4%. The best closure rate after 1 year (85.7%) was achieved with fascia grafts (n=272) and perichondrium (85.7%, n=14). The closure rate of 61.9% with the perichondrium/cartilage graft (n=21) and 71.0% with the fat graft (n=31) was statistically significantly lower (p < 0.05) compared with that with the fascia graft. The postoperative air-bone gap (0.5-4 kHz) was < 10 dB(HL) in 56.2% and < 20 dB(HL) in 79.6% cases compared with 61% and 87%, respectively, in previous series. CONCLUSION Myringoplasty is a safe procedure with a reasonably high success rate. We observed a slight deterioration in the overall results compared with the previous series. This study highlights the importance of systematic quality control and the results and the need for follow-up of the learning curve after the introduction of new surgical techniques and materials.
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Affiliation(s)
- Matti Iso-Mustajärvi
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Aarno Dietz
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Heikki Löppönen
- Department of Otorhinolaryngology - Head and Neck Surgery, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Aksoy MA, Açıkalın MF, Gürbüz MK, Özüdoğru EN, Canaz F, Kaya E, Pınarbaşlı MÖ, İncesulu A, Çaklı H, Cingi C. Efficacy of Platelet-Rich Plasma on Fat Grafts in the Repair of Tympanic Membrane Perforations: An Experimental Study. J Int Adv Otol 2017; 14:58-62. [PMID: 29283097 DOI: 10.5152/iao.2017.3845] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE We investigated the use of autologous platelet-rich plasma (PRP) to improve the success rate of fat graft myringoplasty in perforated tympanic membranes of rats. MATERIALS AND METHODS A total of 20 healthy Wistar albino female rats were divided into two groups. In Group 1, the left tympanic membranes were perforated and grafted with a fat graft that was harvested from the inguinal region. In Group 2, the left tympanic membranes were perforated, and a fat graft was also harvested from the inguinal region. Then, the fat was soaked in 0.5 mL PRP and grafted at the perforation. After the procedure, the rats were examined, and the graft situation was assessed at 3, 5, 7, 10, and 14 days. All of the rats were sacrificed 21 days after perforation, and a histopathological examination was made. RESULTS We compared fat graft histopathological and otomicroscopic findings between the groups. While we did not observe graft rejections in Group 2, we saw 1 case of graft rejection in Group 1. In the histopathological examination, PRP prevents fat graft resorption by the terms of the adipocyte area, granulation tissue area, and vacuolization area. CONCLUSION This study demonstrated the efficacy of fat grafts prepared with PRP on rat tympanic membranes. The fat graft with PRP did not statistically improve the success rate compared to the graft without PRP. Histopatologic findings of the study showed that PRP prevents fat graft resorption. Further studies are needed to further examine the advantages of the graft with PRP.
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Affiliation(s)
- Mehmet Akif Aksoy
- Department of Ear Nose and Throat, Gölköy State Hospital, Ordu, Turkey
| | - Mustafa Fuat Açıkalın
- Department of Pathology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Melek Kezban Gürbüz
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Erkan Niyazi Özüdoğru
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Funda Canaz
- Department of Pathology, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Ercan Kaya
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Mehmet Özgür Pınarbaşlı
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Armağan İncesulu
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Hamdi Çaklı
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - Cemal Cingi
- Department of Ear Nose and Throat, Eskişehir Osmangazi University School of Medicine, Eskişehir, Turkey
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Reply to the letter to the editor concerning: 'Fat-plug myringoplasty of ear lobule vs abdominal donor sites'. Eur Arch Otorhinolaryngol 2017; 274:2665-2667. [PMID: 28213777 DOI: 10.1007/s00405-017-4460-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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12
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Alhabib SF, Saliba I. Hyaluronic Acid Fat Graft Myringoplasty Versus Autologous Platelet Rich Plasma. J Clin Med Res 2016; 9:30-34. [PMID: 27924172 PMCID: PMC5127212 DOI: 10.14740/jocmr2800w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Hyaluronic acid fat graft myringoplasty (HAFGM) is an office-based technique for tympanic membrane perforation (TMP) treatment. It is simple, inexpensive, and performed under local anesthesia at the outpatient office department. We aimed to compare HAFGM technique to a recently described topical use of autologous platelet rich plasma myringoplasty (PRPM) in the repair of TMP. We also aimed to assess the hearing level improvement postoperatively. METHODS We conducted a prospective study in an adult tertiary care center between January 2015 and January 2016. Adult patients presenting with simple TMP were operated randomly using either HAFGM or PRPM under local anesthesia in an office-based setting. Perforations were classified into four grades. Success was considered when complete closure is achieved. Audiometric parameters were evaluated pre- and postoperatively. RESULTS We included 27 patients, of whom 16 were operated with HAFGM and 11 were operated with PRPM. Complete closure was achieved in 81.2% and 18.1%, respectively. Postoperatively, no worsening of bone conduction threshold was noted. The study was abandoned due to the low success rate in patients with PRPM. The pure tone audiometry was improved postoperatively in patients with closed tympanic membrane. CONCLUSIONS The study was aborted because of the unsatisfactory obtained results using PRPM. It confirms once again the beneficial effect of hyaluronic acid in the healing process when added to fat graft myringoplasty. Furthermore, it requires no hospitalization.
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Affiliation(s)
- Salman F Alhabib
- Department of Surgery, Division of Otorhinolaryngology, Head & Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC, Canada
| | - Issam Saliba
- Department of Surgery, Division of Otorhinolaryngology, Head & Neck Surgery, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC, Canada
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Lee JH, Kim DK, Park HS, Jeong JY, Yeon YK, Kumar V, Bae SH, Lee JM, Moon BM, Park CH. A prospective cohort study of the silk fibroin patch in chronic tympanic membrane perforation. Laryngoscope 2016; 126:2798-2803. [PMID: 27297322 DOI: 10.1002/lary.25980] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/27/2016] [Accepted: 02/23/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Silk fibroin patching has been used to repair acute tympanic membrane perforations. Here, we describe the advantages and outcomes of this technique for chronic tympanic membrane perforations. STUDY DESIGN Individual cohort study. METHODS Forty patients were enrolled; half underwent perichondrium myringoplasty, and the silk fibroin patch technique was applied in the remaining patients. We compared the closure, otorrhea, and complication rates; closure time; postoperative hearing gain; and patient satisfaction between the two groups. RESULTS Demographic data (gender, site, age, duration, preoperative air-bone gap, and perforation size and location) were not significantly different between the two groups. The closure rates and times, complication rates, and postoperative hearing gains were also similar in both groups. The mean operative time, otorrhea rate, and complication rate were also significantly better in the silk fibroin patch group. The intraoperative dizziness scores were higher in the conventional perichondrium myringoplasty group. CONCLUSIONS Success rates were similar for the silk fibroin patch technique and conventional perichondrium myringoplasty; however, patching was an easier, faster procedure. Our results suggest that the silk fibroin patch technique is a suitable treatment for chronic tympanic membrane perforation. LEVEL OF EVIDENCE 2b Laryngoscope, 126:2798-2803, 2016.
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Affiliation(s)
- Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Gangwon, South Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Gangwon, South Korea
| | - Hae Sang Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Gangwon, South Korea
| | - Ju Yeon Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea
| | - Yeung Kyu Yeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea
| | - Vijay Kumar
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea
| | - Sung Hee Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea
| | - Jung Min Lee
- Nano-Bio Regenerative Medical Institute, Hallym University, Gangwon, South Korea
| | - Bo Mi Moon
- Nano-Bio Regenerative Medical Institute, Hallym University, Gangwon, South Korea
| | - Chan Hum Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, School of Medicine, Hallym University, Gangwon, South Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Gangwon, South Korea
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Habesoglu M, Oysu C, Sahin S, Sahin-Yilmaz A, Korkmaz D, Tosun A, Karaaslan A. Platelet-Rich Fibrin Plays a Role on Healing of Acute-Traumatic Ear Drum Perforation. J Craniofac Surg 2014; 25:2056-8. [DOI: 10.1097/scs.0000000000001140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Hyaluronic acid fat graft myringoplasty vs fat patch fat graft myringoplasty. Eur Arch Otorhinolaryngol 2014; 272:1873-7. [DOI: 10.1007/s00405-014-2982-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/22/2014] [Indexed: 11/25/2022]
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16
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Acar M, Yazıcı D, San T, Muluk NB, Cingi C. Fat-plug myringoplasty of ear lobule vs abdominal donor sites. Eur Arch Otorhinolaryngol 2014; 272:861-866. [PMID: 24469028 DOI: 10.1007/s00405-014-2890-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2013] [Accepted: 01/13/2014] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to compare the success rates of fat-graft myringoplasties harvesting adipose grafts from different donor sites (ear lobule vs abdomen). The clinical records of 61 patients (24 males and 37 females) who underwent fat-plug myringoplasty (FPM) were reviewed retrospectively. Fat from ear lobule (FEL) and abdominal fat were used as graft materials. The impact of age, gender, systemic diseases, topography of the perforation, utilization of fat graft materials of different origin on the tympanic membrane closure rate and the effect of FPM on hearing gain was analyzed. Our tympanic membrane (TM) closure rate was 82 %. No statistical significant difference was observed regarding age, gender, comorbidities (septal deviation, hypertension and diabetes mellitus) or habits (smoking). Posterior TM perforations had significantly lower healing rate. The change in TM closure rate considering different adipose tissue donor sites was not statistically significant. The hearing gain of the patients was mostly below 20 dB. Fat-plug myringoplasty (FPM) is a safe, cost-effective and easy operation for selected patients. Abdominal fat graft is as effective as ear lobe fat graft on tympanic membrane healing, has cosmetic advantages and should be taken into consideration when planning fat as the graft source.
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Affiliation(s)
- Mustafa Acar
- ENT Department, Yunus Emre State Hospital, Eskisehir, Turkey
| | - Demet Yazıcı
- ENT Department, Tarsus State Hospital, İsmetpaşa Mh., 33440, Tarsus, Mersin, Turkey.
| | - Turhan San
- ENT Department, Göztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Nuray Bayar Muluk
- ENT Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Cemal Cingi
- ENT Department, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
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17
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Shen Y, Guo Y, Wilczynska M, Li J, Hellström S, Ny T. Plasminogen initiates and potentiates the healing of acute and chronic tympanic membrane perforations in mice. J Transl Med 2014; 12:5. [PMID: 24393366 PMCID: PMC3895791 DOI: 10.1186/1479-5876-12-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 12/26/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most tympanic membrane (TM) perforations heal spontaneously, but approximately 10-20% remain open as chronic TM perforations. Chronic perforations can lead to an impaired hearing ability and recurrent middle ear infections. Traditionally, these perforations must be surgically closed, which is costly and time consuming. Therefore, there is a need for simpler therapeutic strategies. Previous studies by us have shown that plasminogen (plg) is a potent pro-inflammatory regulator that accelerates cutaneous wound healing in mice. We have also shown that the healing of TM perforations is completely arrested in plg-deficient (plg(-/-)) mice and that these mice develop chronic TM perforations. In the present study, we investigated the therapeutic potential of local plg injection in acute and chronic TM perforation mice models. METHODS Plg(-/-) mice and wild-type mice were subjected to standardized TM perforations followed by local injection of plg into the soft tissue surrounding the TM. TM perforations with chronic characteristics were induced by leaving TM perforations in plg(-/-) mice untreated for 9 days before treatment. The healing process was observed through otomicroscope and finally confirmed by immunostaining. The quality of TM healing was evaluated based on the morphology of the TM. RESULT Daily local injections of plg into the soft tissue surrounding the TM restored the ability to heal TM perforations in plg-/- mice in a dose-dependent manner, and potentiated the healing rate and quality in wild-type mice. A single local injection of plg initiated the healing of the chronic-like TM perforations in these mice, resulting in a closed TM with a continuous but rather thick outer keratinocyte layer. However, three plg injections led to a completely healed TM with a thin keratinizing squamous epithelium covering a connective tissue layer. CONCLUSION Our data suggests that plg is a promising drug candidate for the treatment of chronic TM perforations in humans.
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Affiliation(s)
| | | | | | | | | | - Tor Ny
- Department of Medical Biochemistry and Biophysics, Umeå University, SE-901 87 Umeå, Sweden.
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