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Faramarzi M, Faramarzi A, Roosta S, Pishgar S, Owji SH. Hyaluronic Acid Gel as Middle Ear and External Auditory Canal Packing Material in Tympanoplasty. Otolaryngol Head Neck Surg 2024; 170:853-861. [PMID: 37811664 DOI: 10.1002/ohn.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/01/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE This study aims to evaluate the effect of hyaluronic acid gel (HAG) on tympanic membrane (TM) graft success rate and audiometric outcomes in patients with large TM perforations during tympanoplasty. STUDY DESIGN A single-blinded randomized controlled trial. SETTING Tertiary hospital. METHODS In the study, we performed tympanoplasty via postauricular approach on 488 ears and compared 2 groups: the control group (n = 247) with absorbable gelatin sponge packing and the HAG group (n = 241) with HAG packing in both the middle ear and medial 2/3 of the external auditory canal. We compared the graft success rates and postoperative audiometric outcomes between the 2 groups. RESULTS In a study of 488 ears (HAG group = 241, control group = 247), the HAG group had a higher graft success rate of 96.7% (233/241 ears) compared to the control group's 91.5% (226/247 ears; P = .015). No significant difference was observed between HAG and control in postoperative ABG closure within 20 dB (HAG: 66.8% or 161 ears; control: 59.1% or 146 ears; P = .078). There were no significant differences in improvements, compared to their preoperative condition, in mean bone conduction (HAG: -0.1 ± 6.5; control: 1.3 ± 7.6), air conduction (HAG: 8.7 ± 12.1; control: 9.7 ± 13.1), air-bone gap (HAG: 8.8 ± 10.6; control: 8.4 ± 12.0), and speech reception threshold (HAG: 9.4 ± 11.8; control: 9.2 ± 13.5) between the control and HAG groups (two one-sided T test, P < .001). CONCLUSION In tympanoplasty, HAG packing in the middle ear and external auditory canal yields higher graft success rates than absorbable gelatin sponge, while audiometric outcomes are similar for both the HAG and absorbable gelatin sponge packing cohorts.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Faramarzi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sareh Roosta
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sajad Pishgar
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hossein Owji
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Delaney DS, Liew LJ, Lye J, Atlas MD, Wong EYM. Overcoming barriers: a review on innovations in drug delivery to the middle and inner ear. Front Pharmacol 2023; 14:1207141. [PMID: 37927600 PMCID: PMC10620978 DOI: 10.3389/fphar.2023.1207141] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Despite significant advances in the development of therapeutics for hearing loss, drug delivery to the middle and inner ear remains a challenge. As conventional oral or intravascular administration are ineffective due to poor bioavailability and impermeability of the blood-labyrinth-barrier, localized delivery is becoming a preferable approach for certain drugs. Even then, localized delivery to the ear precludes continual drug delivery due to the invasive and potentially traumatic procedures required to access the middle and inner ear. To address this, the preclinical development of controlled release therapeutics and drug delivery devices have greatly advanced, with some now showing promise clinically. This review will discuss the existing challenges in drug development for treating the most prevalent and damaging hearing disorders, in particular otitis media, perforation of the tympanic membrane, cholesteatoma and sensorineural hearing loss. We will then address novel developments in drug delivery that address these including novel controlled release therapeutics such as hydrogel and nanotechnology and finally, novel device delivery approaches such as microfluidic systems and cochlear prosthesis-mediated delivery. The aim of this review is to investigate how drugs can reach the middle and inner ear more efficiently and how recent innovations could be applied in aiding drug delivery in certain pathologic contexts.
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Affiliation(s)
- Derek S. Delaney
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Lawrence J. Liew
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
| | - Joey Lye
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
| | - Marcus D. Atlas
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, WA, Australia
| | - Elaine Y. M. Wong
- Hearing Therapeutics, Ear Science Institute Australia, Nedlands, WA, Australia
- Centre for Ear Sciences, Medical School, The University of Western Australia, Nedlands, WA, Australia
- Faculty of Health Sciences, Curtin Medical School, Curtin University, Bentley, WA, Australia
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Ding Y, Wei R, Li D, Li Y, Tian Z, Xie Q, Liu Y. Comparative study of fibroblast growth factor 2 and ofloxacin ear drops for repairing large traumatic perforations: A randomized controlled study. Am J Otolaryngol 2023; 44:103954. [PMID: 37348245 DOI: 10.1016/j.amjoto.2023.103954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE The objective of this study was to compare the healing outcome of fibroblast growth factor 2 (FGF2), ofloxacin ear drops (OFLX) and spontaneous healing for repairing large traumatic tympanic membrane (TM) perforations. MATERIAL AND METHODS A total of 75 traumatic large perforations with >1/4 of TM were randomly divided into FGF2 (n = 25), OFLX (n = 25), and spontaneous healing (n = 25) groups. The closure rates, closure times, and hearing gains were compared at 3 months. RESULTS At 2 weeks after treatment, the closure rate was 95.8 % in the FGF2 group, 96.0 % in the ofloxacin ear drops group, and 14.3 % in the spontaneous healing group (P < 0.01), respectively. At 3 months after treatment, the closure rate was 100 % in the FGF2 group, 100 % in the OFLX group, and 85.7 % in the spontaneous healing group, no among-group differences were significant (P > 0.05). The mean closure time was 9.69 ± 2.46 days in the FGF2 group, 9.45 ± 2.32 days in the OFLX group, and 30.94 ± 8.95 days in the spontaneous healing group (P < 0.01). The mean ABG was 10.37 ± 2.51 dB for the FGF2 group, 11.01 ± 1.31 dB for the OFLX group, and 10.86 ± 1.94 dB for the spontaneous healing group, no significant difference was found among three groups (P > 0.05). CONCLUSIONS This study suggested that both FGF2 and OFLX significantly shortened the mean closure time and improved the closure rate compared with spontaneous healing for repairing large traumatic perforations, while the healing outcome wasn't significantly different among FGF2 and OFLX groups.
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Affiliation(s)
- Yongqing Ding
- Dept Otolaryngol Head & Neck Surg. Hebei North Univ, Affiliated Hosp 1, 12 Changqing Rd, Zhangjiakou City 075000, Hebei, China
| | - Ruili Wei
- Dept Otolaryngol Head & Neck Surg. Hebei North Univ, Affiliated Hosp 1, 12 Changqing Rd, Zhangjiakou City 075000, Hebei, China
| | - Dong Li
- Dept Otolaryngol Head & Neck Surg. Hebei North Univ, Affiliated Hosp 1, 12 Changqing Rd, Zhangjiakou City 075000, Hebei, China
| | - Yanping Li
- Dept Otolaryngol Head & Neck Surg. Hebei North Univ, Affiliated Hosp 1, 12 Changqing Rd, Zhangjiakou City 075000, Hebei, China
| | - Zedong Tian
- Dept Otolaryngol Head & Neck Surg. Hebei North Univ, Affiliated Hosp 1, 12 Changqing Rd, Zhangjiakou City 075000, Hebei, China
| | - Qi Xie
- Dept Otolaryngol Head & Neck Surg. Hebei North Univ, Affiliated Hosp 1, 12 Changqing Rd, Zhangjiakou City 075000, Hebei, China
| | - Yachao Liu
- Dept Otolaryngol Head & Neck Surg. Hebei North Univ, Affiliated Hosp 1, 12 Changqing Rd, Zhangjiakou City 075000, Hebei, China.
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Celik S, Kilic O, Zenginkinet T, Tuysuz O, Kalcioglu MT. The Effect of Platelet-Rich Fibrin and Hyaluronic Acid on Perforation of Nasal Septum. Am J Rhinol Allergy 2022; 36:719-726. [PMID: 35635128 DOI: 10.1177/19458924221104547] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Conservative approaches and surgical methods have been tried for the treatment of nasal septum perforations (NSPs), but a satisfactory method has not yet been determined. OBJECTIVE Our study aimed to investigate the effect of platelet-rich fibrin (PRF) and hyaluronic acid (HA) in repairing NSPs, which were experimentally created in rabbit septum. METHODS A total of 36 white New Zealand rabbits were included in the study. Perforations measuring 0.7 × 0.7 cm were created in their nasal septa. No additional intervention was made to the control group, which was the first group. For the second, third, and fourth groups, respectively, HA, PRF, and HA + PRF were used in the NSP region. Macroscopic and histopathological evaluations were performed after 40 days. RESULTS In the first group, closure was observed in none of the rabbits' NSPs. In the second group, 6 rabbits (66.7%) had full closure in their NSPs. In the third group, the NSP of 6 rabbits (66.7%) was completely closed. In the fourth group, the NSP of 7 rabbits (77.8%) had full closure. CONCLUSION Statistically significant closure was achieved with PRF and/or HA in rabbits in which NSP was established. These materials can be used to increase the likelihood of perforations closing.
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Affiliation(s)
- Serdal Celik
- 485544Istanbul Medeniyet University Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Osman Kilic
- 485544Istanbul Medeniyet University Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - Tulay Zenginkinet
- Istanbul Medeniyet University Faculty of Medicine, Department of Pathology, Istanbul, Turkey
| | - Ozan Tuysuz
- 485544Istanbul Medeniyet University Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
| | - M Tayyar Kalcioglu
- 485544Istanbul Medeniyet University Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey
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Tissue engineering and regenerative medicine strategies for the repair of tympanic membrane perforations. BIOMATERIALS AND BIOSYSTEMS 2022; 6:100046. [PMID: 36824158 PMCID: PMC9934438 DOI: 10.1016/j.bbiosy.2022.100046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 03/24/2022] [Accepted: 03/27/2022] [Indexed: 11/20/2022] Open
Abstract
Despite the high success rate of autologous grafts in tympanic membrane repair, clinical alternatives are required for the closure of unresponsive chronic perforations that can lead to recurring infection and hearing loss. Tissue engineering and regenerative medicine approaches have emerged as another strategy to repair the eardrum, in addition to negating the need for donor tissue harvest and related surgical iatrogenicities. This review highlights the main approaches using biomaterials, growth factors, and cell therapies towards the healing of complex TM perforations. In addition, we discuss the challenges and advances for the development of reliable animal models, which will allow the optimisation and development of novel techniques. Finally, we indicate technologies that are currently used clinically and others that are closer to the market. The advances here discussed on tissue engineering and regenerative medicine strategies applied to the field of TM perforations will allow otologists, surgeons, and researchers to better bring novel technologies to the bedside as well as to develop new ones.
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Duek I, Oron Y, Handzel O, Abu Eta R, Muhanna N, Warshavsky A, Horowitz G, Ungar OJ. To patch or not to patch acute isolated traumatic tympanic membrane perforations: a case series and systematic literature review. Eur Arch Otorhinolaryngol 2021; 279:4313-4323. [PMID: 34817658 DOI: 10.1007/s00405-021-07185-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To date, there is no consensus about the benefits of paper patching over spontaneous healing in the management of isolated acute traumatic tympanic membrane perforations (IATTMP). In this systematic literature review and case series, we compared paper patching of IATTMP to spontaneous healing in terms of healing rate and time to heal. DATABASES REVIEWED A systematic literature search of English-language studies published from 1/1975 to 9/2020 was conducted using PubMed via MEDLINE, and 201 studies were identified. Another 346 studies were derived from the references of those articles. Twenty-four studies remained after omitting duplications and articles that did not meet the inclusion criteria. METHODS Demographics, medical history, physical examination, and audiometric results in the selected publications and in a new series of patients treated for IATTMP between 1/2018 and 1/2021 in a single tertiary referral center were retrieved and analyzed. RESULTS The literature review yielded 2796 ears of which 466 underwent paper patching (intervention arm). Complete perforation healing was documented in 67-97% of control arm and 92-93% of intervention arm. Our new series included 29 ears of which six underwent paper patching. Complete healing was observed in 83% and 78% in the interventional and control arms, respectively. CONCLUSIONS Although paper patching and watchful waiting had similar success rates in patients with IATTMP, healing after paper patching was slightly quicker among our patients. Patching is a readily applicable and technically simple office-based intervention that should be preferentially considered for IATTMP.
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Affiliation(s)
- Irit Duek
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Rani Abu Eta
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Nidal Muhanna
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Anton Warshavsky
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Gilad Horowitz
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel
| | - Omer J Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 6 Weizman Street, 6423906, Tel Aviv, Israel.
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Hussain Z, Pei R. Necessities, opportunities, and challenges for tympanic membrane perforation scaffolding-based bioengineering. Biomed Mater 2021; 16. [PMID: 33260166 DOI: 10.1088/1748-605x/abcf5d] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/01/2020] [Indexed: 02/08/2023]
Abstract
Tympanic membrane (TM) perforation is a global clinical dilemma. It occurs as a consequence of object penetration, blast trauma, barotrauma, and middle ear diseases. TM perforation may lead to otitis media, retraction pockets, cholesteatoma, and conductive deafness. Molecular therapies may not be suitable to treat perforation because there is no underlying tissue matrix to support epithelium bridging. Chronic perforations are usually reconstructed with autologous grafts via surgical myringoplasty. Surgical treatment is uncomfortable for the patients. The grafting materials are not perfect because they produce an opaque membrane, fail in up to 20% of cases, and are suboptimal to restore acoustic function. Millions of patients from developing parts of the world have not got access to surgical grafting due to operational complexities, lack of surgical resources, and high cost. These shortcomings emphasize bioengineering to improve placement options, healing rate, hearing outcomes, and minimize surgical procedures. This review highlights cellular, structural, pathophysiological, and perforation specific determinants that affect healing, acoustic and surgical outcomes; and integrates necessities relevant to bioengineered scaffolds. This study further summarizes scaffolding components, progress in scaffolding strategies and design, and engenders limitations and challenges for optimal bioengineering of chronic perforation.
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Affiliation(s)
- Zahid Hussain
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei 230026, People's Republic of China
- CAS Key Laboratory for Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou 215123, People's Republic of China
| | - Renjun Pei
- School of Nano-Tech and Nano-Bionics, University of Science and Technology of China (USTC), Hefei 230026, People's Republic of China
- CAS Key Laboratory for Nano-Bio Interface, Division of Nanobiomedicine, Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences, Suzhou 215123, People's Republic of China
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Ghanad I, Polanik MD, Trakimas DR, Knoll RM, Castillo-Bustamante M, Black NL, Kozin ED, Remenschneider AK. A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty. Laryngoscope 2020; 131:392-400. [PMID: 33176008 DOI: 10.1002/lary.28914] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans. METHODS A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed. RESULTS The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small-intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air-bone gap of 5.6 dB was found in the 23% of studies reporting this metric. CONCLUSIONS The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392-400, 2021.
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Affiliation(s)
- Iman Ghanad
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Marc D Polanik
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, University of Massachusetts Medical School, Worcester, Massachusetts, U.S.A.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, U.S.A
| | - Danielle R Trakimas
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, U.S.A
| | - Renata M Knoll
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | | | - Nicole L Black
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A
| | - Elliott D Kozin
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Aaron K Remenschneider
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, University of Massachusetts Medical School, Worcester, Massachusetts, U.S.A.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, U.S.A
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What is the Role of Hyaluronic Acid Ester in Myringoplasty? Systematic Review and Meta-Analysis. Otol Neurotol 2020; 40:851-857. [PMID: 31246888 DOI: 10.1097/mao.0000000000002274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To reveal odds of tympanic membrane closure and postoperative hearing outcomes for myringoplasty utilizing hyaluronic acid ester via systematic review and meta-analysis. DATA SOURCES 1) Search of English articles in PubMed/Medline, Embase, and Cochrane databases published between January 1, 1998 and March 31, 2018. STUDY SELECTION Inclusion criteria: 1) English language; 2) clinical studies; 3) reported posttreatment perforation status, hearing outcomes, or complications. EXCLUSION CRITERIA hyaluronic acid used for middle ear packing or topical application of hyaluronic acid solution. DATA EXTRACTION Number of patients, surgical technique, mean age, overall rate of tympanic membrane closure, success rate based on size of perforation, mean air-bone gap improvement, and postoperative speech scores and complications. DATA SYNTHESIS Ten studies encompassing 531 patients met criteria. Reported success rates for closure of chronic perforation ranged from 70.0 to 92.7% (mean, 85.21%). Smaller perforation predicted success in complete closure. Mean air-bone gap closure was 10.6 dB (4-24 dB). There were five complications reported. Meta-analysis was performed on five studies. No difference was noted in the success rates between hyaluronic acid ester myringoplasty and conventional tympanoplasty using fascia or perichondrium, with an overall closure rates of 89.8 and 89.4%, respectively (odds ratio [OR] 1.04, 95% confidence interval [CI] 0.59-1.82, p = 0.896). A higher closure rate was seen in hyaluronic acid ester myringoplasty (87.9%) when compared with fat graft myringoplasty (70.8%), (OR 3.01, 95% CI 1.42-6.35, p = 0.004). CONCLUSIONS Hyaluronic acid (HA) ester myringoplasty appears to be safe and effective at attaining complete closure of tympanic membrane perforation, although there exists significant selection bias and inconsistent reporting among existing papers.
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Li X, Zhang H, Zhang Y. Repair of large traumatic tympanic membrane perforation using ofloxacin otic solution and gelatin sponge. Braz J Otorhinolaryngol 2020; 88:9-14. [PMID: 32456874 PMCID: PMC9422449 DOI: 10.1016/j.bjorl.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/02/2020] [Accepted: 03/21/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Traumatic large tympanic membrane perforations usually fail to heal and require longer healing times. Few studies have compared the healing and hearing outcomes between gelatin sponge patching and ofloxacin otic solution. Objectives To compare the healing outcomes of large traumatic tympanic membrane perforations treated with gelatin sponge, ofloxacin otic solution, and spontaneous healing. Methods Traumatic tympanic membrane perforations >50% of the entire eardrum were randomly divided into three groups: ofloxacin otic solution, gelatin sponge patch and spontaneous healing groups. The healing outcome and hearing gain were compared between the three groups at 6 months. Results A total of 136 patients with large traumatic tympanic membrane perforations were included in analyses. The closure rates were 97.6% (40/41), 87.2% (41/47), and 79.2% (38/48) in the ofloxacin otic solution, gelatin sponge patch, and spontaneous healing groups, respectively (p = 0.041). The mean times to closure were 13.12 ± 4.61, 16.47 ± 6.24, and 49.51 ± 18.22 days in these groups, respectively (p < 0.001). Conclusions Gelatin sponge patch and ofloxacin otic solution may serve as effective and inexpensive treatment strategies for traumatic large tympanic membrane perforations. However, ofloxacin otic solution must be self-applied daily to keep the perforation edge moist, while gelatin sponge patching requires periodic removal and re-patching.
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Affiliation(s)
- Xiuguo Li
- Jining NO.1 People's Hospital, Department of Otolaryngology, Shandong Province, China
| | - Hui Zhang
- Jining Medical University, Department of Histology and Embryology, Shandong Province, China
| | - Yuanyuan Zhang
- Jining NO.1 People's Hospital, Department of Otolaryngology, Shandong Province, China.
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Abi Zeid Daou C, Bassim M. Hyaluronic acid in otology: Its uses, advantages and drawbacks - A review. Am J Otolaryngol 2020; 41:102375. [PMID: 31862122 DOI: 10.1016/j.amjoto.2019.102375] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 12/10/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Review of the literature for studies involving the use of hyaluronic acid (HA) in otology. METHODS Pubmed and OvidMedline were searched using a combination of the following words in different variations: hyaluronic acid, hyaluronate, otolaryngology, otology, ear, tympanic membrane, perforation, tympanostomy, tympanoplasty, myringoplasty, packing, middle ear, cochlea, gene delivery, gene therapy, cochlear implant, hearing loss, meniere, vertigo, otitis and cholesteatoma. RESULTS The papers relevant for this review were triaged based on abstracts and titles and were then categorized based on topic/disease entity/procedure. The papers were read and summarized in order to use their findings in this review. CONCLUSIONS HA is being recently used as adjuvant therapy for multiple inflammatory conditions and in tissue repair. These immunomodulatory properties and biocompatibility have interested researchers specially in the field of otology for repair, gene delivery, immunomodulation etc. Recent data in the field show optimistic results for the use of HA in several conditions especially tympanic membrane perforations and gene delivery. It also establishes the role of HA as ancillary treatment in many other otologic pathologies. This review presents the most recent findings on the use of HA in otology. The results could be used to guide clinical practice and incite further research based on the presented results of the literature.
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Pinho AMDMR, Kencis CCS, Miranda DRP, Sousa Neto OMD. Traumatic perforations of the tympanic membrane: immediate clinical recovery with the use of bacterial cellulose film. Braz J Otorhinolaryngol 2019; 86:727-733. [PMID: 31526712 PMCID: PMC9422489 DOI: 10.1016/j.bjorl.2019.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/06/2019] [Accepted: 05/11/2019] [Indexed: 11/26/2022] Open
Abstract
Introduction Perforation of the tympanic membrane is a reasonably frequent diagnosis in otorhinolaryngologists’ offices. The expectant management is to wait for spontaneous healing, which usually occurs in almost all cases in a few weeks. However, while waiting for healing to be completed, the patients may experience uncomfortable symptoms. Although some research suggests the use of various materials to aid in the recovery of the tympanic membrane, none presented robust evidence of improvement in the cicatricial process. Nevertheless, the occlusion of the perforation with some material of specific texture and resistance can alleviate the patients’ symptoms and accelerate the healing process. Objective To evaluate the clinical (symptomatic and functional) improvement after the placement of bacterial cellulose film (Bionext®) on tympanic membrane perforations (traumatic). Methods We evaluated 24 patients, victims of traumatic perforations of the tympanic membrane, who were evaluated in the Otorhinolaryngology Emergency Room. Following otoscopy and audiometric examination was performed, before and after the use of cellulose film occluding the tympanic membrane perforation. Results Twenty-four patients were included, whose degree of overall discomfort caused by the tympanic membrane perforation and the presence of symptoms of autophonia, ear fullness and tinnitus were investigated. The mean score attributed to the overall annoyance caused by tympanic membrane perforation was 7.79, decreasing to a mean value of 2.25 after the film application. Symptom evaluation also showed improvement after using the film: autophonia decreased from a mean value of 6.25 to 2.08, tinnitus from 7 to 1.92 and ear fullness from 7.29 to 1.96. The auditory analysis showed mean threshold values still within the normal range at low and medium frequencies, with slight hearing loss at acute frequencies, but with significant improvement at all frequencies, with the exception of 8000 Hz, after film use. Conclusion The use of bacterial cellulose film fragment on traumatic perforations of the tympanic membrane promoted immediate functional and symptomatic recovery in the assessed patients.
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Tachibana T, Kariya S, Orita Y, Makino T, Haruna T, Matsuyama Y, Komatsubara Y, Naoi Y, Nakada M, Noda Y, Sato Y, Nishizaki K. Spontaneous closure of traumatic tympanic membrane perforation following long-term observation. Acta Otolaryngol 2019; 139:487-491. [PMID: 30957610 DOI: 10.1080/00016489.2019.1592225] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Traumatic tympanic membrane perforation (TTMP) is usually managed conservatively because most close spontaneously within a few months. Nevertheless, spontaneous closure of TTMP during long-term observation has not been well described in the literature. OBJECTIVES The present study investigated factors associated with spontaneous closure of TTMP, and the characteristics of cases exhibiting spontaneous closure following long-term observation. MATERIALS AND METHODS The medical records of 40 patients with TTMP who visited the authors' hospital were retrospectively reviewed. RESULTS Spontaneous closure was observed in 27 (67.5%) patients. The healing period was <2 weeks in 6 cases, <4 weeks in 9, <3 months in 5, <6 months in 3, and ≥6 months in 4. All four cases in which spontaneous closure took ≥6 months exhibited a sign of spontaneous closure at 6 months following injury. Perforation in contact with the malleus was associated with a lower frequency of spontaneous closure. CONCLUSIONS AND SIGNIFICANCE In TTMP, surgery should be considered in patients who exhibit perforation in contact with the malleus. However, it has also been suggested that long-term observation may be a viable treatment option when a sign of spontaneous closure is observed within 6 months following injury.
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Affiliation(s)
- Tomoyasu Tachibana
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Hyogo, Japan
| | - Shin Kariya
- Departments of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Okayama City, Okayama, Japan
| | - Yorihisa Orita
- Department of Otolaryngology Head and Neck Surgery, Kumamoto University Graduate School of Medicine, Kumamoto City, Kumamoto, Japan
| | - Takuma Makino
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Hyogo, Japan
| | - Takenori Haruna
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Hyogo, Japan
| | - Yuko Matsuyama
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Hyogo, Japan
| | - Yasutoshi Komatsubara
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Hyogo, Japan
| | - Yuto Naoi
- Department of Otolaryngology, Japanese Red Cross Society Himeji Hospital, Himeji City, Hyogo, Japan
| | | | - Yohei Noda
- Departments of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Okayama City, Okayama, Japan
| | - Yasuharu Sato
- Department of Pathology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama City, Okayama, Japan
| | - Kazunori Nishizaki
- Departments of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Okayama City, Okayama, Japan
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Lou ZC, Wei H, Lou ZH. Pretreatment factors affecting traumatic tympanic membrane regeneration therapy using epidermal growth factor. Am J Otolaryngol 2018; 39:711-718. [PMID: 30078511 DOI: 10.1016/j.amjoto.2018.07.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The use of epidermal growth factor (EGF) to achieve closure of human traumatic tympanic membrane perforations (TMPs) was recently reported. However, pretreatment factors affecting healing outcomes have seldom been discussed. This study was performed to evaluate pretreatment factors contributing to the success or failure of TMP healing using EGF. DESIGN AND PARTICIPANTS This was a retrospective cohort study of 95 TMPs who were observed for at least 6 months after EGF treatment. Eleven factors considered likely to affect healing outcome were evaluated by univariate and multivariate logistic regression analyses. INTERVENTIONS Each traumatic TMP was treated by daily topical application of EGF. The main outcome measures were complete closure versus failure to close and mean closure time. RESULTS A total of 95 patients were included in the analyses. The total closure rate was 92.6% at 6 months, and the mean closure time was 10.5 ± 4.8 days. The closure rate was not significantly different according to the duration of perforation ≤3 days and >3 days (P = 0.816). However, the mean closure time was significantly different according to the duration of perforation (P < 0.001). The perforation size did not affect the closure rate (P = 0.442). The mean closure time in the low-dose EGF group was significantly shorter than that in the high-dose EGF group (P = 0.001). Logistic regression analyses showed that perforations with preexisting myringosclerosis were more likely to fail to close compared to those without preexisting myringosclerosis (P = 0.001). Multivariate logistic regression analyses showed that the duration of perforation (P = 0.011), size of perforation (P < 0.001), and involvement of the malleus in perforation (P = 0.005) were factors independently correlated with closure time. CONCLUSIONS Daily application of EGF can be used to treat all traumatic TMPs. The size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dosage was sufficient to keep the eardrum moist. Multivariate logistic regression analyses revealed a significant correlation between preexisting myringosclerosis and failure to heal. Nevertheless, the size of perforation, starting time of application, and malleus injury were independent prognostic factors for prolonged healing time.
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Affiliation(s)
- Zheng-Cai Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang 322000, China.
| | - Hong Wei
- Department of Ophthalmology, West China Hospital Sichuan University, Sichuan, 610000, China.
| | - Zi-Han Lou
- Department Clinical Class No.11, Clinical Medicine, Xinxiang Medical University, Henan 453003, China.
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Comparing Spontaneous Closure and Paper Patching in Traumatic Tympanic Membrane Perforations. J Craniofac Surg 2018; 29:1922-1924. [DOI: 10.1097/scs.0000000000005047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Huang P, Zhang S, Gong X, Wang X, Lou ZH. Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations. Braz J Otorhinolaryngol 2018; 84:545-552. [PMID: 28823697 PMCID: PMC9452262 DOI: 10.1016/j.bjorl.2017.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 06/07/2017] [Accepted: 06/30/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic. Objective This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation. Methods In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n = 57) and Gelfoam patch-treated group (n = 57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months. Results Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p > 0.05). However, the total average closure time was significantly different between the two groups (26.8 ± 9.1 days in the spontaneous healing group vs. 14.7 ± 9.1 days in the Gelfoam patch-treated group, p < 0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1 ± 1.6 days vs. 12.6 ± 3.9, medium-sized perforations: 13.3 ± 2.2 days vs. 21.8 ± 4.2 days, and large perforations: 21.2 ± 4.7 days vs. 38.4 ± 5.7 days; p < 0.01). Conclusion In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.
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Lou ZC, Lou Z. Efficacy of EGF and Gelatin Sponge for Traumatic Tympanic Membrane Perforations: A Randomized Controlled Study. Otolaryngol Head Neck Surg 2018; 159:1028-1036. [PMID: 30060707 DOI: 10.1177/0194599818792019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the outcomes of epidermal growth factor (EGF) and gelatin sponge patch treatments for traumatic tympanic membrane perforations. STUDY DESIGN Prospective, randomized, controlled. SETTING University-affiliated teaching hospital. SUBJECTS AND METHODS In total, 141 perforations encompassing >50% of the eardrum were randomly divided into 3 groups: EGF (n = 47), gelatin sponge patch (n = 47), and observation (n = 47). The edges of the perforations were not approximated. The closure rate, mean closure time, and infection rate were evaluated at 6 months and the related factors analyzed. RESULTS A total of 135 perforations were analyzed. At 6 months, the closure rates were 97.8%, 86.7%, and 82.2% in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively (P = .054). The mean ± SD closure time was 11.12 ± 4.60, 13.67 ± 5.37, and 25.65 ± 13.32 days in the EGF, gelatin sponge patch, and spontaneous healing groups, respectively (P < .001). In addition, the presence of infection was not significantly associated with rate of closure in any group. CONCLUSIONS As compared with spontaneous healing, daily application of EGF and gelatin sponge patching reduced the closure time of traumatic tympanic membrane perforations. EGF treatment had a higher closure rate and shorter closure time but resulted in otorrhea. By contrast, gelatin sponge patches did not improve the closure rate or cause otorrhea but required repeated patch removal and reapplication. Thus, the appropriate treatment should be selected according to patient need.
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Affiliation(s)
- Zheng Cai Lou
- Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University, Zhejiang, China
| | - Zihan Lou
- Department Clinical Class No. 11, Clinical Medicine, Xinxiang Medical University, Henan, China
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Ballivet de Régloix S, Crambert A, Salf E, Maurin O, Pons Y, Clément P. Early Tympanoplasty Using a Synthetic Biomembrane for Military-Related Blast Induced Large Tympanic Membrane Perforation. Mil Med 2018; 183:e624-e627. [DOI: 10.1093/milmed/usy055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/14/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stanislas Ballivet de Régloix
- Percy Military Training Hospital, ENT – Head and Neck Surgery Department, 101, Avenue Henri Barbusse, Clamart, France
| | - Anna Crambert
- Percy Military Training Hospital, ENT – Head and Neck Surgery Department, 101, Avenue Henri Barbusse, Clamart, France
| | - Eric Salf
- Legouest Military Training Hospital, ENT – Head and Neck Surgery Department, 27, Avenue de Plantieres, Metz Cedex 3, France
| | - Olga Maurin
- Fire Fighting Brigade of Paris, Emergency Department, 1, Place Jules Renard, Paris, France
| | - Yoann Pons
- Percy Military Training Hospital, ENT – Head and Neck Surgery Department, 101, Avenue Henri Barbusse, Clamart, France
| | - Philippe Clément
- Percy Military Training Hospital, ENT – Head and Neck Surgery Department, 101, Avenue Henri Barbusse, Clamart, France
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Gao T, Li X, Hu J, Ma W, Li J, Shao N, Wang Z. Management of traumatic tympanic membrane perforation: a comparative study. Ther Clin Risk Manag 2017; 13:927-931. [PMID: 28769569 PMCID: PMC5533469 DOI: 10.2147/tcrm.s139631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This prospective study was conducted to evaluate the efficacy of sea buckthorn oil patches in treating traumatic tympanic membrane (TM) perforations. We enrolled 370 patients with traumatic TM perforations of different sizes. These patients were randomly assigned to control group and treatment group. In the treatment group, a sterile cotton patch with sea buckthorn oil was used to cover the TM perforations. In the control group, patients were treated with a sterile cotton patch. The healing rate and time were compared between the two groups. We found that the overall healing rate was significantly higher in the treatment group than in the control group. For middle and large TM perforations, sea buckthorn oil treatment led to a significant increase in the healing rate. At 2 months after injury, the duration of healing was, generally, shorter in the treatment group than in the control group (P<0.05). In conclusion, sea buckthorn oil patches are effective in treating middle and large TM perforations, which results in increased healing rates and decreased healing time.
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Affiliation(s)
- Tianxi Gao
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Xiaoli Li
- Department of Dermatology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Juan Hu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Weijun Ma
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Jingjing Li
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Na Shao
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Zhenghui Wang
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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Sayin I, Gunes S, Ekizoglu O. Treatment of traumatic tympanic membrane perforations. Eur Arch Otorhinolaryngol 2017; 274:2357-2358. [PMID: 28265746 DOI: 10.1007/s00405-017-4508-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/10/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Ibrahim Sayin
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Sağlam Caddesi, No: 11, 34147, Bakırköy, Istanbul, Turkey.
| | - Selcuk Gunes
- Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr. Sadi Konuk Teaching and Research Hospital, Tevfik Sağlam Caddesi, No: 11, 34147, Bakırköy, Istanbul, Turkey
| | - Oguzhan Ekizoglu
- Department of Forensic Medicine, Tepecik Training and Research Hospital, Izmir, Turkey
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Lou ZC. Effect of hyaluronic acid with or without scaffold material on the regeneration of tympanic membrane perforations. Eur Arch Otorhinolaryngol 2016; 274:2353-2355. [DOI: 10.1007/s00405-016-4168-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 06/22/2016] [Indexed: 12/29/2022]
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Goncalves S, Bas E, Goldstein BJ, Angeli S. Effects of Cell-Based Therapy for Treating Tympanic Membrane Perforations in Mice. Otolaryngol Head Neck Surg 2016; 154:1106-14. [PMID: 26980912 DOI: 10.1177/0194599816636845] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/11/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the effectiveness of scaffold-embedded mesenchymal stem cells (MSCs) as a topical treatment for healing tympanic membrane perforations (TMPs) in a mouse model. STUDY DESIGN Prospective animal study. SETTING Experimental. SUBJECTS AND METHODS In vitro: under sterile conditions, porcine-derived (Gelita-Spon [GS]), hyaluronate-derived (EpiDisc [ED]), and polyvinyl alcohol (PVA) scaffolds were cut into small pieces and cocultured with murine bone marrow-derived MSCs (BM-MSCs) expressing green fluorescent protein (GFP) for 72 hours. The cultures were either analyzed by confocal microscopy or used for subsequent in vivo experiments. In vivo: 26 mice were divided into 3 groups (ie, control [n = 9], GS [n = 8], ED [n = 9]). Under general anesthesia, TMPs of equal sizes were performed bilaterally using a sterile 27-gauge needle under a surgical microscope. The BM-MSCs embedded within GS or ED scaffolds were soaked in phosphate-buffered saline and then topically applied on right TMPs, and scaffolds alone were applied on left TMPs 6 to 8 hours after injury. Control mice did not receive treatment. On day 7, animals were euthanized and bullae were harvested for histological analysis. RESULTS In vitro: BM-MSCs grew well on both GS (P = .0012) and ED (P = .0001) scaffolds compared with PVA. In vivo: 100% of untreated (control) TMPs remained open after 7 days. Animals treated with MSC-embedded ED scaffolds had a higher percentage of TMP closure (P = .016) and a thicker neotympanum (P = .0033) than control animals. The experimentally applied BM-MSCs engrafted and differentiated into epithelial cells suggested by the colocalized expression of cytokeratin-19 and GFP. CONCLUSIONS The topical application of bone marrow-derived MSCs enhances the healing of TMPs in this animal model and is a promising alternative to tympanoplasty.
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Affiliation(s)
- Stefania Goncalves
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida, USA
| | - Esperanza Bas
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida, USA
| | - Bradley J Goldstein
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida, USA Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Simon Angeli
- Department of Otolaryngology-Head and Neck Surgery, University of Miami Miller School of Medicine, University of Miami Ear Institute, Miami, Florida, USA
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Lou Z. In response to: Hyaluronic acid fat graft myringoplasty vs. fat patch fat graft myringoplasty. Eur Arch Otorhinolaryngol 2016; 273:2855-6. [PMID: 26879992 DOI: 10.1007/s00405-016-3934-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/08/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated Yiwu Hospital of Wenzhou Medical University, 699 Jiangdong Road, Yiwu, 322000, Zhejiang, China.
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Lou ZC, Yang J, Tang Y, Fu YH. Topical application of epidermal growth factor with no scaffold material on the healing of human traumatic tympanic membrane perforations. Clin Otolaryngol 2016; 41:744-749. [PMID: 26825650 DOI: 10.1111/coa.12627] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE We evaluated the effects of conservative treatment and topical application of epidermal growth factor (EGF) with no scaffold material on the healing of human traumatic tympanic membrane perforations (TMPs). STUDY DESIGN Prospective, randomised clinical trial. METHODS A prospective analysis was performed between January 2015 and March 2015 for the treatment of human traumatic TMPs. The closure rate, closure time, hearing gain and rate of purulent otorrhoea were compared between the topical application of EGF and conservative treatment. RESULT In total, 97 patients were analysed. The total closure rates did not significantly differ between the observation and EGF groups (83.0% versus 92.0%, P = 0.182). The total average closure time in the observation group was significantly longer than in the EGF group (25.1 ± 10.5 versus 11.7 ± 5.2 days, P = 0.001). When the closure rate was evaluated according to perforation size, no significant difference was seen for medium or large perforations (P = 0.18 and 0.21, respectively). When closure time was evaluated according to perforation size, a significant difference was seen for medium and large perforations (P = 0.001). CONCLUSIONS This study suggests that topical application of EGF with no scaffold material may significantly shorten the closure time of human traumatic TMPs. Such a shorter recovery time may lead to reduced healthcare costs. This alternative technique to a classic myringoplasty is particularly beneficial and suitable for the closure of large human traumatic TMPs.
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Affiliation(s)
- Z C Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, 322000, China
| | - J Yang
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, 322000, China
| | - Y Tang
- Department of pathology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, 322000, China
| | - Y H Fu
- Department of General Medicine, Wenzhou Medical University, Renji College, Zhejiang, 325035, China
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Zhengcai-Lou, Zihan-Lou, Yongmei-Tang. Comparative study on the effects of EGF and bFGF on the healing of human large traumatic perforations of the tympanic membrane. Laryngoscope 2015; 126:E23-8. [PMID: 26451761 DOI: 10.1002/lary.25715] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/09/2015] [Accepted: 09/10/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS We evaluated the effects of epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) on the healing of large traumatic tympanic membrane perforations (TMPs). STUDY DESIGN Prospective clinical study. SETTING Tertiary university hospital. METHODS A randomized, prospective analysis was performed between June 2013 and August 2014 on the treatment of traumatic TMPs larger than 25% of the TM. Closure rate, closure time, hearing gain, and rate of otorrhea were compared between EGF and bFGF groups, as well as to an observation-only group. RESULTS Final analysis was performed on 86 patients at 3 months. The closure rates of perforation in the EGF, bFGF, and observation groups were 86.2%, 89.3%, and 72.4%, respectively. The closure rates in the EGF and bFGF groups were 14% to 17% higher than in the observation group, although the difference was not statistically significant for the total closure rate among the three groups (P = 0.200). The average closure time was significantly longer (P < 0.01) in the observation group than in the EGF and bFGF groups. However, the closure times in the EGF and bFGF groups were not significantly different (P = 0.92). In addition, differences in purulent otorrhea rates among the groups were not statistically significant (P = 0.82). CONCLUSIONS Both EGF and bFGF can accelerate the closure of human large traumatic TMPs. The healing outcomes among the two growth factors were not significantly different.
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Affiliation(s)
- Zhengcai-Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
| | - Zihan-Lou
- Department of Clinical Medicine, Xinxiang Medical University, Henan, People's Republic of China
| | - Yongmei-Tang
- Department of Pathology, The Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, People's Republic of China
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Spontaneous closure of traumatic tympanic membrane perforations: observational study. The Journal of Laryngology & Otology 2015; 129:950-4. [DOI: 10.1017/s0022215115002303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:The treatment of traumatic tympanic membrane perforations varies in different investigations, ranging from observation to early surgical repair. The present study aimed to focus on the closure rate and the closure time in a group of patients treated with a watchful waiting policy.Methods:The study comprised 133 consecutive patients with a total of 137 perforations. Data were evaluated in terms of aetiology, location and size of perforation, audiometric findings, closure rate, and closure time.Results:The overall closure rate was 97 per cent. For patients with a known closure time within three months, the median closure time was between three and four weeks. The probability of spontaneous closure over time was further analysed with Kaplan–Meier plots, for those perforations with known closure times and for all perforations including those with unknown closure times. Perforation size was the only significant determining factor for closure time.Conclusion:Small perforations had a high probability of spontaneous closure within three to four weeks, justifying a watchful waiting policy. Larger uncomplicated perforations might warrant early surgical repair, depending on the patient's needs and the availability of surgery.
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Early Paper Patching Versus Observation in Patients With Traumatic Eardrum Perforations. J Craniofac Surg 2014; 25:2030-2. [DOI: 10.1097/scs.0000000000001027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
OBJECTIVE To compare the healing outcomes of higher and lower doses of basic fibroblast growth factor (bFGF) on human traumatic tympanic membrane perforation (TMP). STUDY DESIGN Prospective clinical study. METHODS All patients with traumatic TMP were treated by direct application of bFGF, and were sequentially allocated into one of two groups: lower-dose group (2-3 drops of bFGF solution daily, approximately 0.1-0.15 mL) and higher-dose group (5-6 drops of bFGF solution daily, approximately 0.25-0.3 mL). The results of closure rate, closure time, and rate of otorrhea between the higher- and lower-dose groups were compared at 3 months. RESULTS In total, 126 patients were included in this study. The higher-dose group showed significantly improved purulent otorrhea rate compared with the lower-dose group (p < 0.01) for perforations of the same size, although the closure rate of the middle-sized perforations did not differ significantly between higher- and lower-dose groups (p > 0.05). However, the lower-dose group had a significantly shorter closure time of 5 d compared with the higher-dose group (p < 0.05). In addition, although the lower-dose group showed shorter healing times (about 3 d) compared to the higher-dose group for large-sized perforations, the dosage of bFGF did not significantly affect the large-sized perforation closure rate (p > 0.05) or closure time (p > 0.05). Nine large-sized perforations with secondary purulent otorrhea achieved complete closure, with closure times of 7-25 (14.2 ± 5.8) d. CONCLUSION This study suggested that continued daily application of a lower dose of bFGF not only shortens the closure time of human traumatic TMP but also avoids secondary purulent otorrhea.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical College , Yiwu , China and
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