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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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Current Concepts and Future Trends in Increasing the Benefits of Cochlear Implantation: A Narrative Review. Medicina (B Aires) 2022; 58:medicina58060747. [PMID: 35744010 PMCID: PMC9229893 DOI: 10.3390/medicina58060747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 01/29/2023] Open
Abstract
Hearing loss is the most common neurosensory disorder, and with the constant increase in etiological factors, combined with early detection protocols, numbers will continue to rise. Cochlear implantation has become the gold standard for patients with severe hearing loss, and interest has shifted from implantation principles to the preservation of residual hearing following the procedure itself. As the audiological criteria for cochlear implant eligibility have expanded to include patients with good residual hearing, more attention is focused on complementary development of otoprotective agents, electrode design, and surgical approaches. The focus of this review is current aspects of preserving residual hearing through a summary of recent trends regarding surgical and pharmacological fundamentals. Subsequently, the assessment of new pharmacological options, novel bioactive molecules (neurotrophins, growth factors, etc.), nanoparticles, stem cells, and gene therapy are discussed.
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Scarpa A, Marra P, Ralli M, Viola P, Gioacchini FM, Chiarella G, Salzano FA, De Luca P, Ricciardiello F, Cassandro C, Corbi GM. Comparison of different oval window sealing materials in stapes surgery: systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2022; 279:5521-5533. [PMID: 35857099 PMCID: PMC9649504 DOI: 10.1007/s00405-022-07551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/07/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To compare the efficacy and safety characteristics of different materials used for oval window sealing during stapedotomy. METHODS A systematic review was conducted according to the PRISMA guidelines. Published international English literature from January 1, 2000 to December 2021 was screened, checking for studies that compared different materials utilization in patients undergoing stapedotomy surgery for otosclerosis or congenital stapes fixation. Data related to the efficacy and safety of each material were extracted. The primary outcome measure was the air-bone gap (ABG) closure after surgical intervention. RESULTS Six studies were included in the metanalysis. Because of the heterogeneity of the treatments adopted, we assessed the use of the fat compared to all other treatments, and the use of the gelfoam compared to all other treatments. In the former analysis (fat vs others) we did not identify differences in ABG closure between the groups (p = 0.74), with a low heterogeneity of the results (I2 = 28.36%; Hedge's g = 0.04, 95% CI - 0.19 0.27); similarly, we did not identify differences between the use of gelfoam and other treatments (p = 0.97), with a low heterogeneity of the results (I2 = 28.91%; Hedge's g = 0.00, 95% CI - 0.20 0.21). CONCLUSIONS Numerous options are available for oval window sealing during stapedotomy, with acceptable safety and effectiveness profiles. Based on the current data, no definitive recommendation can be made regarding the choice of one material over another, and the convenience of sealing over no sealing at all.
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Affiliation(s)
- Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Pasquale Marra
- Department of Medicine, Surgery and Dentistry, University of Salerno, Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Rome, Italy
| | - Pasquale Viola
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Federico Maria Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Unit of Audiology, Regional Centre for Cochlear Implants and ENT Diseases, Magna Graecia University, Catanzaro, Italy
| | - Francesco Antonio Salzano
- Department of Medicine, Surgery and Dentistry, University of Salerno, Largo Città di Ippocrate, 84131 Salerno, Italy
| | - Pietro De Luca
- Department of Medicine, Surgery and Dentistry, University of Salerno, Largo Città di Ippocrate, 84131 Salerno, Italy
| | | | | | - Grazia Maria Corbi
- Department Medicine and Health Sciences, University of Molise, Campobasso, Italy
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Faramarzi M, Pedramfard P, Roosta S, Kazemi T, Aboughadare H. Evaluating hearing results in stapedotomy: Comparison of fluoroplastic Causse loop piston and Matrix prosthesis. Laryngoscope Investig Otolaryngol 2021; 6:1289-1295. [PMID: 34938864 PMCID: PMC8665457 DOI: 10.1002/lio2.675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/04/2021] [Accepted: 09/15/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE We carried out this research to assess and compare post-stapedotomy hearing results of Matrix titanium prosthesis with a Teflon piston prosthesis, specifically the fluoroplastic (Teflon) Causse loop piston prosthesis in patients who suffered from otosclerosis. METHODOLOGY In this retrospective study, Causse loop piston prosthesis was used in 81 ears, and the Matrix prosthesis was applied in 44 ears. For pairwise matching with Matrix prosthesis, 44 out of 81 Causse loop piston-treated ears were selected based on preoperative audiometric data. Then, postoperative audiometric results of these two groups were compared. The main outcomes were pure tone audiometric results and air-bone gap (ABG) closure before and after the surgery. Incidence of postoperative sensorineural hearing loss was also evaluated and compared between the two groups. RESULTS The results revealed no significant difference in improvement of speech reception threshold, mean air conduction, bone conduction gain, ABG closure, and incidence of postoperative sensorineural hearing loss at the frequencies of 0.5-4 kHz between the two groups. However, performance of Matrix prosthesis was better in ABG closure at a frequency of 250 Hz. CONCLUSION Herein, similar postoperative improvement was achieved at the frequencies of 0.5-4 kHz; nevertheless, Matrix provided better ABG closure at frequency of 250 Hz in short term. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Mohammad Faramarzi
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
- Department of Otorhinolaryngology – Head & Neck SurgeryShiraz University of Medical SciencesShirazIran
| | - Pegah Pedramfard
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
| | - Sareh Roosta
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
| | - Tayebeh Kazemi
- Otolaryngology Research CenterShiraz University of Medical SciencesShirazIran
- Department of Otorhinolaryngology – Head & Neck SurgeryShiraz University of Medical SciencesShirazIran
| | - Hanie Aboughadare
- Student Research Committee, School of MedicineShiraz University of Medical SciencesShirazIran
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