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Kutbi AH, Malas M, Al-Talhi AA, Noori F, Amoodi HA. The Effect of Using Ofloxacin Ear Drops in Traumatic Tympanic Membrane Healing: A Systematic Review and Meta-Analysis. EAR, NOSE & THROAT JOURNAL 2024:1455613241264479. [PMID: 38907707 DOI: 10.1177/01455613241264479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
Objectives: To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled trials (RCTs). Data Sources: Medline/PubMed, CENTRAL, Clinical Trials.Gov, and Google Scholar. Study Selection: Inclusion criteria: (1) English language; (2) RCT studies; (3) reported the outcomes on the application of ofloxacin and outcomes of spontaneous healing. Exclusion criteria: (1) studies without a control group; (2) patient with severe otologic disease such as chronic suppurative otitis media or ossicular disruption or patients with craniocerebral injury; (3) studies with no pretreatment values or single-arm clinical studies. Data Extraction: Country, year of publication, number of participants in each arm, patient characteristics such as age, sex, intervention details, laterality, cause of TM perforation, position of perforation, follow-up time, hearing gain, rate of TM closure, and closure time. Results: A total of 6 RCTs studies were analyzed. A total of 502 participants were included; the relative risk for closure rate of ofloxacin treatment was 1.18 [95% confidence interval (CI), 1.08 to 1.28, P < .001] and the mean difference (MD) for healing time was -18.4 (95% CI, -19.96 to -16.82, P < .001), suggesting ofloxacin has a significant effect on closure of TM perforations. However, no clinically significant effect in hearing (SMD: 0.21, 95% CI, 0.02 to 0.40, P = .03) was seen in ofloxacin group. Also, patients in the ofloxacin group were associated with a 13% reduction in the risk of infections compared to their observation-assigned counterparts, but this estimate was not statistically significant. Conclusion: Ofloxacin use in patients with traumatic TM perforation is effective in reducing healing time and increasing rate of TM perforation closure. No evidence of increased risk of hearing loss or infection rates are encountered when ofloxacin is prescribed to patients with traumatic TM perforation.
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Affiliation(s)
- Abdullah H Kutbi
- Otolaryngology-Head and Neck Surgery, Surgery Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Moayyad Malas
- Department of Otolaryngology, East Jeddah Hospital, Ministry of Health, Jeddah, Saudi Arabia
| | - Atheer Ali Al-Talhi
- Otolaryngology-Head and Neck Surgery, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Faisal Noori
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Hosam A Amoodi
- Department of Medicine, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
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Hirobumi I. A Successful Case Report of Epipharyngeal Abrasive Therapy (EAT) in a Patient With Sleep Apnea Syndrome and Traumatic Tympanic Membrane Perforation Caused by Chronic Epipharyngitis. Cureus 2024; 16:e59089. [PMID: 38680824 PMCID: PMC11052600 DOI: 10.7759/cureus.59089] [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] [Accepted: 04/26/2024] [Indexed: 05/01/2024] Open
Abstract
Traumatic perforation of the tympanic membrane often occurs in Japanese patients who scratch their ears to relieve itching. Traumatic tympanic membrane perforation may close spontaneously, but the perforation may remain. One of the causes of prolonged tympanic membrane perforation closure is dysfunction of the Eustachian tube. In this study, I experienced a case of chronic epipharyngitis causing ear fullness and itching, and a traumatic perforation of the tympanic membrane caused by scratching with an earpick. The patient also had sleep apnea syndrome (SAS). Treatment of chronic epipharyngitis with epipharyngeal abrasive therapy (EAT) shortened the time to perforation closure and improved SAS, suggesting that EAT affected the improvement of Eustachian tube function and airway resistance in the epipharynx.
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Lou Z, Lou Z, Yu D, Wang J, Lv T, Chen Z. Comparison of perichondrium-cartilage double and single underlay myringoplasty for subtotal perforations: a randomized controlled trial. Eur Arch Otorhinolaryngol 2023; 280:4861-4868. [PMID: 37178167 DOI: 10.1007/s00405-023-08004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE The objective of this study was to compare graft outcome, operation time and surgical complications of the double and single perichondrium-cartilage underlay techniques for repairing subtotal tympanic membrane (TM) perforations. MATERIALS AND METHODS Patients with unilateral subtotal perforations undergoing myringoplasty were prospectively randomized to undergo DPCN or SPCN. The operation time, graft success rate, audiometric outcomes, and complications were compared between these groups. RESULTS In total, 53 patients with unilateral subtotal perforations were included (DPCN group, 27; SPCN group, 26).All patients completed 6 months of follow-up. The mean operation time was 41.2 ± 1.8 min in the DPCN group and 37.2 ± 5.4 min in the SPCN group, the difference was not significant (p = 0.613).The graft success rates were 96.3% (26/27) in the DPCN group and 73.1% (19/26) in the SPCN group, the difference was significant (p = 0.048). During the period of follow-up, residual perforation was found at postoperative in one (3.7%) in the DPCN group, while cartilage graft slipped (graft lateralization) in 2 (7.7%) and residual perforation in 5 (19.2%) were found in the SPCN group, the difference of residual perforation was not significant among two group (p = 0.177).In addition, no significant between-group differences were observed pre- (p = 0.741) or post- (p = 0.687) operative ABG values or mean ABG gain (p = 0.659) (Table 2).The functional success rates (postoperative ABG ≤ 20 dB) were 85.2% (23/27) in the DPCN group and 73.1% (19/26) in the SPCN group (p = 0.454). CONCLUSION Although similar functional result and operation time can be obtained with double perichondrium-cartilage underlay technique compared to the single perichondrium-cartilage underlay technique for endoscopic closure of subtotal perforations, double unerlay technique offers better anatomical result with minimum complications.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Province, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Dongzhen Yu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Jingjing Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Tian Lv
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang Province, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, China.
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, Shanghai, 200233, China.
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China.
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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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Scaria SM, Frumm SM, Vikram EP, Easow SA, Sheth AH, Shamir ER, Yu SK, Tward AD. Epimorphic regeneration in the mammalian tympanic membrane. NPJ Regen Med 2023; 8:58. [PMID: 37852984 PMCID: PMC10584978 DOI: 10.1038/s41536-023-00332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
Adult mammals are generally believed to have limited ability to regenerate complex tissues and instead, repair wounds by forming scars. In humans and across mammalian species, the tympanic membrane (TM) rapidly repairs perforations without intervention. Using mouse models, we demonstrate that the TM repairs itself through a process that bears many hallmarks of epimorphic regeneration rather than typical wound healing. Following injury, the TM forms a wound epidermis characterized by EGFR ligand expression and signaling. After the expansion of the wound epidermis that emerges from known stem cell regions of the TM, a multi-lineage blastema-like cellular mass is recruited. After two weeks, the tissue architecture of the TM is largely restored, but with disorganized collagen. In the months that follow, the organized and patterned collagen framework of the TM is restored resulting in scar-free repair. Finally, we demonstrate that deletion of Egfr in the epidermis results in failure to expand the wound epidermis, recruit the blastema-like cells, and regenerate normal TM structure. This work establishes the TM as a model of mammalian complex tissue regeneration.
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Affiliation(s)
- Sonia M Scaria
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Stacey M Frumm
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Ellee P Vikram
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Sarah A Easow
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Amar H Sheth
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Eliah R Shamir
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Shengyang Kevin Yu
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Aaron D Tward
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA.
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Bishnoi T, Marlapudi SK, Sahu PK. Factors Influencing the Outcome of Spontaneous Healing of Traumatic Tympanic Membrane Perforation: A Clinical Prospective Observational Study. Indian J Otolaryngol Head Neck Surg 2023; 75:1774-1781. [PMID: 37636775 PMCID: PMC10447838 DOI: 10.1007/s12070-023-03722-4] [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: 01/26/2023] [Accepted: 03/20/2023] [Indexed: 08/29/2023] Open
Abstract
Trauma to the ear is typically attributed to its location in the craniofacial skeleton. TM is prone to rupture, tear, or perforation when traumatized. Etiological factors may be classified according to the pathogenetic mechanisms (air-pressure change, heat, solids, water pressure). MATERIALS & METHOD This is a prospective study of 70 patients with traumatic tympanic membrane perforation between January 2019 and December 2022. Inclusion and exclusion criteria applied and results interpreted. RESULTS Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76 years. Traumatic TM affects all age groups with a mean age of 27.94 ± 4.76 years, with the highest incidence among the middle-aged groups 61.4%. The male-to-female ratio was found to be 1.9:1, with high predominance among male patients (65.7%) with a frequency of 57.1% for slap injury group in our study contrary to others. Spontaneous healing was observed in 88.6% over a follow-up period of 12 weeks in this study. Our study has not shown that associated comorbidities influence healing (P = 0.550). About 45.5% Marginal perforations have not healed in 12 weeks follow-up period as compared to central perforations 5.1%. CONCLUSION There is a high predominance of TM perforation among male patients in our study may be attributed to activity. Spontaneous healing is more common. Duration of healing was significantly affected by the size of the perforation with longer duration for large perforations and vice versa. It is observed in this study that the duration of spontaneous healing is longer in blast injuries when compared to other kinds of injuries. A significant proportion of marginal perforations that have not healed in our study may be attributed to annular ligament involvement.
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Affiliation(s)
- Tapasya Bishnoi
- Department of ENT-HNS, Command Hospital Airforce, Bangalore, India
| | | | - P. K. Sahu
- Department of ENT-HNS, Command Hospital Airforce, Bangalore, India
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Lou J, Liu Y, Lou Z, Lou Z, Chen Z. Endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforations with 3 years of follow-up. Am J Otolaryngol 2023; 44:103902. [PMID: 37150123 DOI: 10.1016/j.amjoto.2023.103902] [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: 03/08/2023] [Revised: 04/07/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate graft outcomes and complications of endoscopic perichondrium-cartilage H type technique for repairing chronic kidney-shaped perforation with 3 years of follow-up. MATERIAL AND METHODS Adult patients with chronic kidney-shaped perforation underwent endoscopic perichondrium-cartilage H type technique. The graft outcomes and complications were evaluated at 36 months after surgery. RESULTS The total of 51 ears were included in this study. The mean operation time was 31.5 ± 4.1 min. Residual perforation was seen in 2 patients, the graft success rate was 96.1 % (49/51) at postoperative 12 months. Granular myringitis was noted in 8.2 % (4/49) patients in 49 patients with graft success. The mean preoperative ABG was 23.6 ± 3.7 dB, while the mean postoperative ABG postoperatively 12 months was 12.9 ± 5.2 dB (P < 0.05), the functional success rate was 94.1 % (48/51). At postoperative 36 months, only 32 (62.7 %, 32/51) patients were followed up, while 19 (37.3 %, 19/51) patients lost followup. Of the 32 patients with followup of 36 months, the mean follow-up time was 38.2 ± 7.1 (37-46) months, re-perforation was seen in one. All 32 patients performed the postoperative CT examination at last followup, CT revealed the well pneumatization of mastoids and middle ear. CONCLUSIONS Endoscopic cartilage-perichondrium H type technique is an alternative method for repairing chronic kidney-shaped perforations, with a highly successful, short operation time, minimally invasive procedure, and no cholesteatoma.
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Affiliation(s)
- Jianhua Lou
- Department of Operating Theater, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City 322000, Zhejiang Province, China
| | - Yachao Liu
- Department of Otolaryngol Head & Neck Surgery, the First Affiliated Hospital of Hebei North University, 12 Changqing Rd, Zhangjiakou City 075000, Hebei Province, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City 322000, Zhejiang Province, China.
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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Pollastri F, Locatello LG, Bruno C, Maggiore G, Gallo O, Pecci R, Giannoni B. Otoendoscopy in the era of narrow-band imaging: a pictorial review. Eur Arch Otorhinolaryngol 2023; 280:1683-1693. [PMID: 36129549 PMCID: PMC9988719 DOI: 10.1007/s00405-022-07656-5] [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: 08/03/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Otoendoscopy represents the initial non-invasive diagnostic cornerstone for external and middle ear disorders. Recently, new techniques of enhanced imaging such as narrow-band imaging (NBI) have been introduced but their role as a potential aid in otological practice remains unproven. In this pictorial review, we want to present the potential application of this endoscopic method, highlight its limitations, and give some hints regarding its future implementation. METHODS Representative cases of external and/or middle ear pathologies were selected to illustrate the role of NBI in this regard. RESULTS NBI may represent a useful aid in the otological work-up, in the differential diagnosis of ear tumor-like masses, and, possibly, in the prognosis of tympanic perforations. For other ear disorders, instead, this technique does not seem to add anything to the standard clinical practice. CONCLUSIONS NBI might prove useful in the assessment of selected external and middle ear disorders but its role must be prospectively validated.
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Affiliation(s)
- Federica Pollastri
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy. .,Department of Neuroscience, Psychology, Drug's Area and Child's Health, University of Florence, Florence, Italy.
| | | | - Chiara Bruno
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | | | - Oreste Gallo
- Department of Otorhinolaryngology, Careggi University Hospital, Florence, Italy
| | - Rudi Pecci
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Beatrice Giannoni
- Unit of Audiology, Oncological and Robotic Head and Neck Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Neuroscience, Psychology, Drug's Area and Child's Health, University of Florence, Florence, Italy
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Liu Y, Ding Y, Li Y, Xin Y, Li D, Lin Y. Endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations. Am J Otolaryngol 2022; 43:103231. [PMID: 34537512 DOI: 10.1016/j.amjoto.2021.103231] [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: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE The objective of this study was evaluate the short-and long-term graft outcome and complications of endoscopic modified perichondrium-cartilage sandwich graft for repairing chronic subtotal and total perforations. STUDY DESIGN Prospective case series. MATERIALS AND METHODS 135 patients with chronic subtotal and total perforations who underwent endoscopic modified perichondrium-cartilage sandwich graft technique. The graft success rate, hearing outcome, and complications were evaluated at postoperative 6 and 24 months. RESULTS 124 patients were finally included in this study. The graft success rate was 96.3% in subtotal perforation and 97.7% in total perforation (P = 0.874), with an overall success rate of 96.8% at postoperative 6 months. The graft success rate was 95.8% (68/71) in subtotal perforation and 94.9% (37/39) in total perforation (P = 0.795), with an overall success rate of 95.5% (105/110) at postoperative 24 months. The mean ABG improved from 28.0 ± 5.3 dB preoperatively to 14.9 ± 4.8 dB postoperatively 12 months (P < 0.05) for subtotal perforations; from 33.4 ± 7.4 dB preoperatively to 16.1 ± 2.4 dB postoperatively 12 months (P < 0.05) for total perforations. No graft-related complications (e.g., graft lateralization, significant blunting, graft medialization) were encountered during the follow-up period. Of the 110 patients, temporal bone CT revealed well pneumatization of the middle ear and mastoid region. However, graft keratin pearl was noticed in 1.8% (2/110) patients. CONCLUSIONS Endoscopic modified perichondrium-cartilage sandwich graft for repairing subtotal and total perforations had excellent short and long-term graft success rate with less time-consuming and minimal complications.
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10
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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 2022; 88:9-14. [PMID: 32456874 PMCID: PMC9422449 DOI: 10.1016/j.bjorl.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [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, Jining, China
| | - Hui Zhang
- Jining Medical University, Department of Histology and Embryology, Jining, China
| | - Yuanyuan Zhang
- Jining NO.1 People's Hospital, Department of Otolaryngology, Jining, China.
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11
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Lou Z, Jin K, Sun J. Endoscopic inlay cartilage and perichondrium myringoplasty for repairing large perforations in teenagers. Int J Pediatr Otorhinolaryngol 2021; 151:110915. [PMID: 34507235 DOI: 10.1016/j.ijporl.2021.110915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/07/2021] [Accepted: 09/03/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study compared the long-term graft success rates and hearing outcomes of overlay-underlay and underly cartilage myringoplasty for repairing large perforations in Teenagers. STUDY DESIGN prospective, randomized study. SETTING Tertiary referral center. METHODS Pediatric patients older than 12 years with chronic perforations were randomly divided into two groups:intervention group (n = 39) and control group (n = 41). The graft success rate, hearing improvement, and complications were compared between the two groups. RESULTS A total of 80 patients were included in this study. The graft success rate was 100% in the intervention group and 95.1% in the control group at postoperative 3 months, the difference wasn't significant (P = 0.496). Also, the graft success rate was not significantly different between the two groups at 12 months postoperatively (100.0% vs 87.8%, p = 0.073). However, the difference of graft success rate was significant between the two groups at 24 months postoperatively (97.4% vs 75.6%, p = 0.012). CT examination revealed well-pneumatized middle ears 24 months after surgery in both group. However, epithelial pearls near the umbo were seen at 31 months postoperatively in one patient in the observation group. CONCLUSIONS Compared to the endoscopic cartilage with perichondrium composite graft underlay technique, endoscopic perichondrial graft overlay and cartilage underlay had a better long-term graft success rate and lower rate of long-term re-perforation in teenagers. However, the graft technique had no effect on hearing outcome.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China.
| | - Kangfeng Jin
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City, 322000, Zhejiang province, China
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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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Transcanal Endoscopic Cartilage and Perichondrium Graft Myringoplasty for Large Tympanic Membrane Perforations. Otol Neurotol 2021; 42:1172-1176. [PMID: 33782256 DOI: 10.1097/mao.0000000000003141] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The objective of this study was to evaluate the outcomes following transcanal endoscopic cartilage and perichondrium double-layer myringoplasty for subtotal and total tympanic membrane (TM) perforations. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. METHODS Adult patients who underwent transcanal endoscopic double-layer myringoplasty for subtotal and total TM perforations between January 2015 and December 2017 were included. The graft success rate, hearing outcomes, and complications were evaluated postoperatively. Temporal bone computed tomography or magnetic resonance imaging was performed at 24 months postoperatively. RESULTS The mean follow-up period was 28.2 ± 6.1 (range, 24-36) months. The graft success rate was in 95.7% (45/47) at 6 months, 93.6% (44/47) at 12 months, and 87.2% (41/47) at 24 months, respectively. The mean ABG improved from 32.89 ± 5.31 dB preoperatively to 10.89 ± 4.78 dB postoperatively 12 months (p < 0.05) for subtotal perforations; from 33.41 ± 7.41 dB preoperatively to 11.45 ± 2.41 dB postoperatively 12 months (p < 0.05) for total perforations. No graft-related complications (e.g., graft lateralization, significant blunting, graft atelectasis, graft adhesions, or effusion) were encountered during the follow-up period. Postoperative temporal bone imaging revealed a pneumatized middle ear and mastoid in all cases with no evidence of cholesteatoma. CONCLUSIONS Transcanal endoscopic myringoplasty for large TM perforations using a double-layer perichondrium and cartilage graft is feasible with comparable rates of closure to more invasive approaches.
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Simani L, Oron Y, Handzel O, Eta RA, Warshavsky A, Horowitz G, Muhanna N, Ungar OJ. Paper Patching Versus Watchful Waiting of Traumatic Tympanic Membrane Perforations: A Meta-Analysis. Laryngoscope 2021; 131:2091-2097. [PMID: 33881175 DOI: 10.1002/lary.29580] [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: 01/23/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of the study was to investigate the healing rates, the restoration of hearing, and the time for complete healing of paper patching versus watchful waiting for traumatic tympanic membrane perforations (TTMPs). STUDY DESIGN Systematic review with meta analysis. METHODS Publications were selected by a search on "PubMed," "Embase," and "Web of Science." A meta-analysis of risk ratios for paper patching (intervention arm) and watchful waiting (control arm) was performed. RESULTS Five studies describing 393 TTMPs were included in the quantitative meta-analysis. TTMP healing rates ranged between 84.2% and 95.2% in the intervention arm and between 76.7% and 84.8% in the control arm. The pooled risk ratio of healed TTMPs was significantly higher in the intervention arm than in the control arm (risk ratio: 1.12, 95% confidence interval: 1.04-1.21). CONCLUSIONS TTMPs have high healing potential with and without intervention. The healing rate of paper patching was superior to that of watchful waiting alone. LEVEL OF EVIDENCE NA Laryngoscope, 131:2091-2097, 2021.
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Affiliation(s)
- Liam Simani
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, 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, 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, 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, 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, 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, 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, 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, Tel-Aviv, Israel
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The Effectiveness of bFGF in the Treatment of Tympanic Membrane Perforations: A Systematic Review and Meta-Analysis. Otol Neurotol 2021; 41:782-790. [PMID: 32097362 PMCID: PMC7302323 DOI: 10.1097/mao.0000000000002628] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Objective: To investigate the effectiveness of basic fibroblast growth factor (bFGF) versus placebo or no intervention in the treatment of tympanic membrane (TM) perforations from randomized controlled trials (RCTs), prospective and retrospective studies. Data Sources: PubMed, EMBASE, and Cochrane databases were screened from their inceptions to June 2019. Study Selection: Inclusion criteria: 1) English language; 2) observational (retrospective or prospective) or treatment (RCT) studies; 3) reported the outcomes on the application of bFGF in adult or pediatric population. Exclusion criteria: 1) studies without a control group; 2) animal studies, in vitro studies, review studies, and case reports. Data Extraction: Number of patients, cause of TM perforation, perforation size, treatment, mean age, follow-up time, sex, closure rate, healing time, mean air-bone gap improvement. Data Synthesis: A total of 14 studies were included, including seven RCTs and seven non-RCTs with a total of 1,072 participants. The odds ratio for closure rate of bFGF treatment was 7.33 (95% confidence interval [CI], 4.65 to 11.53; p < 0.01; I2 = 44%) and the standardized mean difference (SMD) for healing time was –5.89 (95% CI: –7.85 to –3.93, p < 0.01, I2 = 98%), suggesting bFGF application has a significant effect on closure of TM perforations. However, no significant change in hearing (SMD: 0.08, 95% CI: –0.11 to 0.27, p = 0.39, I2 = 0%) was seen as a result of bFGF treatment. Conclusions: Our meta-analysis has revealed that the application of bFGF can significantly enhance the closure rate as well as shorten the healing time for TM perforations. In terms of hearing, there is as yet no evidence that bFGF has a significant effect. Given its ease, availability, and safety, bFGF can be used effectively for TM repair.
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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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Lou Z. Blood clots affect the response of tympanic membrane perforations to gelfoam grafting after ventilation tube insertion. J Otolaryngol Head Neck Surg 2021; 50:6. [PMID: 33509256 PMCID: PMC7845100 DOI: 10.1186/s40463-021-00496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 01/21/2021] [Indexed: 12/03/2022] Open
Abstract
Chronic tympanic membrane (TM) perforation associated with ventilation tube (VT) insertion was commonly encountered in pediatric patients with chronic otitis media with effusion (COME) treatment and eustachian tube dysfunction. The persistent perforation require surgical closure by myringoplasty. Song JS et al. recently a paper entitled: “Evaluating short and long term outcomes following pediatric myringoplasty with gelfoam graft for tympanic membrane perforation following ventilation tube insertion.” In their study, the authors performed gelfoam myringoplasty to repair the perforations following VT insertion in children and compare the successful TM closure rate among different graft materials. The authors believed that gelfoam alone was superior to hyaluronic acid (HA), tragal cartilage (TC), and gelfoam-plus-temporal fascia (TF). The sample size is unbalanced and incommensurable between gelfoam and other graft materials. In addition, a confounding factor was added in the gelfoam group, thereby affected the assessment of TM closure. Thus, the conclusion is not rigorous and scientific.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu central Hospital, 699 Jiangdong Road, Yiwu city, 322000, Zhejiang Province, China.
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Heitmann D, Scheffler B, Abrams J, Gerstner AOH. [Spontaneous course of traumatic tympanic membrane perforations]. HNO 2021; 69:192-197. [PMID: 33452545 DOI: 10.1007/s00106-020-00991-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Traumatic eardrum perforation is a common presentation in otorhinolaryngologic practices and emergency clinics. A consistent management strategy (active intervention vs. watchful waiting) is, however, still lacking. OBJECTIVE In the following study, the outcome of watchful waiting is analyzed and presented. MATERIALS AND METHODS A collective of 272 patients presenting at two different specialist ENT practices within days of traumatic tympanic membrane perforation from June 2002 to March 2019 were analyzed. Treatment was non-surgical, with prospective monitoring. Whereas antibiotics were not given at all in one practice, they were given only upon signs of infection in the other practice. The outcome was evaluated retrospectively on the basis of patient files. RESULTS The collective consisted of 185 males and 87 females. Mean age was 30 years (range: 7 months to 82 years). The perforations were most commonly located in the upper anterior and lower posterior quadrants. According to Griffin grading, the size was grade I in 97%. The three most common causes were impact to the ear, barotrauma, and foreign bodies. Under a watchful waiting regimen, 95% of the patients presenting for follow-up checks showed complete closure. CONCLUSION Watchful waiting can be assessed as appropriate in traumatic eardrum perforation, provided otorhinolaryngologic follow-up is ensured. An exception is blast injury, which is now much less common in Central Europe, as this is associated with a risk of secondary cholesteatomas. In these rare cases, active treatment with surgical exploration of the middle ear including relining the perforation is indicated.
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Affiliation(s)
- D Heitmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum Braunschweig, Holwedestraße 16, 38118, Braunschweig, Deutschland
| | | | - J Abrams
- Überregionale HNO-Gemeinschaftspraxis, Hamm, Deutschland
| | - A O H Gerstner
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Klinikum Braunschweig, Holwedestraße 16, 38118, Braunschweig, Deutschland.
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Lou Z, Li X. A comparative study of endoscopic cartilage myringoplasty used to treat wet and dry ears with mucosal-type chronic otitis media. J Laryngol Otol 2020; 134:1-6. [PMID: 32753085 DOI: 10.1017/s0022215120001486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The outcomes of dry and wet ears were compared following endoscopic cartilage myringoplasty performed to treat chronic tympanic membrane perforations in patients with mucosal chronic otitis media. METHODS Patients with chronic perforations, and with mucosal chronic otitis media with or without discharge, were recruited; all underwent endoscopic cartilage myringoplasty. The graft success rate and hearing gain were evaluated at six months post-operatively. RESULTS The graft success rates were 85.9 per cent (67 out of 78) in dry ears and 86.2 per cent (25 out of 29) in wet ears; the difference was not significant (p = 0.583). Among the 29 wet ears, the graft success rates were 100 per cent in 11 ears with mucoid discharge and 77.8 per cent in the 18 patients with mucopurulent otorrhoea. CONCLUSION The wet or dry status of ears in patients with chronic perforations with mucosal chronic otitis media did not affect graft success rate or hearing gain after endoscopic cartilage myringoplasty. However, ears with mucopurulent discharge were associated with increased failure rates and graft collapse, whereas ears with mucoid discharge were associated with higher graft success rates.
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Affiliation(s)
- Z Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, China
| | - X Li
- Department of Otolaryngology, Jining No. 1 People's Hospital, China
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Application of mesenchymal stem cell for tympanic membrane regeneration by tissue engineering approach. Int J Pediatr Otorhinolaryngol 2020; 133:109969. [PMID: 32126416 DOI: 10.1016/j.ijporl.2020.109969] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 02/22/2020] [Accepted: 02/22/2020] [Indexed: 12/13/2022]
Abstract
Regeneration is a biological process of cell renewal that takes place in damaged tissues or organs. It is naturally stimulated by the release of different growth factors, cytokines, surface molecules, and stem cells at the wounded sites. The tympanic membrane (TM) is an essential component of the hearing process in the auditory system, which can amplify and transmit sound vibrations through a chain of mobile ossicles. Middle ear infection, external sound pressure, insertion of sharp objects into the ear, and severe trauma are the main causes of TM perforations (TMPs), which could result in deficient hearing function. So far, otolaryngologists have employed surgical procedures (myringoplasty or tympanoplasty) to close the perforated eardrum. Because of limitations such as side effects, discomfort, and high cost to patients, there is a need for better alternatives to surgical procedures. Tissue engineering is a promising tool that can overcome the operational risk and restore, maintain, and improve the function of the TM using a range of biocompatible scaffolds, commercially available growth factors, and stem cells. Currently, multipotent mesenchymal stem cells (MSCs) are a good therapeutic option for the treatment of TMPs because of their self-renewing, and autocrine and paracrine activities. As there are fewer risks of isolation in the use of MSCs for the treatment of TMPs, they are more advantageous for tissue regeneration. The delivery of either MSCs alone or a combination of MSCs with biomaterials and growth factors (GFs) at the ruptured TM sites may enhance the activation of epithelial stem cell markers and increase the migration and proliferation of keratinocytes resulting in faster closure of TMPs. This review focuses on the current strategies used to treat TMPs and the importance of MSCs in TM regeneration. Particularly, we have discussed the synergistic effect of MSCs and scaffolds or GFs or scaffolds/GFs in TM regeneration. Finally, with the advancement of tissue engineering technologies such as 3D and 4D bioprinting, MSCs can be used to design patient-specific scaffolds, which may contain physical and chemical guidance cues to improve the extent and rate of targeted tissue regeneration.
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Epidermal growth factor on the healing of human subacute tympanic membrane perforation. Am J Otolaryngol 2020; 41:102399. [PMID: 31948693 DOI: 10.1016/j.amjoto.2020.102399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/09/2020] [Indexed: 11/22/2022]
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, the affilitaed Yiwu Hospital, Yiwu city, Zhejiang provice, China
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The effects of everted or inverted edges on healing of traumatic-induced tympanic membrane perforations. The Journal of Laryngology & Otology 2019; 133:1092-1096. [DOI: 10.1017/s0022215119002445] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivesTo evaluate the healing and hearing outcomes related to the everted or inverted edge area on slap- and fist-induced large tympanic membrane perforations.MethodsA total of 120 patients with slap- or fist-induced tympanic membrane perforations, with inverted or everted edges, affecting 50–75 per cent of the entire tympanic membrane, were randomly divided into 2 groups: an edge approximation group and a spontaneous healing group. The edge approximation group was divided into subgroups A and B based on the reversed edge area (reversed edge was more or less than 50 per cent of the total perforation, respectively). Healing outcomes and hearing improvements at six months were compared.ResultsThe data of 118 patients were analysed. The closure rate of perforations in subgroup A, subgroup B, and the spontaneous healing group was 90.9 per cent, 92.1 per cent and 84.5 per cent, respectively; the difference between the three groups was not significant (p = 0.393).ConclusionThe area of reversed edges for slap- or fist-induced tympanic membrane perforations did not seem to affect healing and hearing outcomes, regardless of edge approximation and everted or inverted edges.
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Lou ZC. Dose- and starting time-dependent effect of the application of EGF to the regeneration of traumatic eardrum. Acta Otolaryngol 2019; 139:1083-1089. [PMID: 31553254 DOI: 10.1080/00016489.2019.1667533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Some studies have shown that topical application of epidermal growth factor (EGF) accelerates healing in traumatic tympanic membrane perforations (TMPs), however, the optimal dose and starting time of application have not been established.Objectives: To determine the optimal dose and starting time of application of EGF for the regeneration of TMPs.Methods and materials: Patients with traumatic TMPs were first randomly assigned to low-dose EGF, high-dose EGF, and spontaneous healing groups. Then, the same patients were retrospectively analyzed at 6 months based on the starting time of treatment. The closure times, closure rates, and hearing gain were compared among the groups at 6 months.Results: The mean closure time was 10.20 ± 5.13 days in the low-dosage EGF group, 14.39 ± 6.20 days in the high-dosage EGF group, and 33.17 ± 16.37 days in the spontaneous healing group; the difference was significant (p < .001).Conclusions: Daily application of EGF shortened the closure time of traumatic TMPs compared with those that healed spontaneously. However, high-dose EGF instead prolonged the closure time compared to low-dose EGF.
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Affiliation(s)
- Zheng Cai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Zhejiang, China
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Xie P, Peng Y, Hu J, Peng A, Yi S. Assessment of hearing loss induced by tympanic membrane perforations under blast environment. Eur Arch Otorhinolaryngol 2019; 277:453-461. [PMID: 31691016 DOI: 10.1007/s00405-019-05710-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSES This study provides an approach to estimating tympanic membrane perforation-induced hearing loss (HL) using a human middle ear model. METHODS Sixty-one cases of tympanic membrane perforation originating from fireworks were reported from the Ear-Nose-Throat Department. The otoscope, audiometry data and diagnosis records were organized, and gender, age, etiology, perforation size and diseased ear side were classified as independent variables. A multinomial regression model was used to analyze the potential effects of the variables on HL. Meanwhile, a human middle ear model was implemented to calculate the ensued HL resulting from different perforation areas and sites. In addition, linear regression models were used to establish functions between perforation size and HL. RESULTS The audiometry data indicate that HL at high frequencies (f > 2 kHz) is much more profound than that at the speech frequency band (f < 1 kHz). Compared with mild HL (<15 dB), mediate HL (15-30 dB) was correlated with the perforation area (p < 0.05, 95% CI), while severe HL (>30 dB) was affected by both perforation size and age (p < 0.05, 95% CI). However, other factors, including gender and diseased ear side, do not show a statistically significant effect on HL. Furthermore, the Kruskal-Wallis test result reveals that HL at frequencies of 0.25 kHz ≤ f ≤ 8 kHz is strongly associated with the perforation size (p < 0.05, 95% CI). CONCLUSIONS It is conclusive that HL is positively proportional to the perforation size. However, HL is not correlated with the perforation site for small perforation areas of < 10% (p > 0.05, 95% CI).
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Affiliation(s)
- Pengpeng Xie
- Key Laboratory of Traffic Safety On Track, Ministry of Education, School of Traffic and Transportation Engineering, Central South University, Changsha, China.,Joint International Research Laboratory of Key Technology for Rail Traffic Safety, Central South University, Changsha, China
| | - Yong Peng
- Key Laboratory of Traffic Safety On Track, Ministry of Education, School of Traffic and Transportation Engineering, Central South University, Changsha, China. .,National and Local Joint Engineering Research Center of Safety Technology for Rail Vehicle, Central South University, Changsha, China.
| | - Junjiao Hu
- Department of of RadiologyThe Second Xiangya Hospital, Central South University, Changsha, China
| | - Anquan Peng
- Department of Otolaryngology-Head and Neck Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shengen Yi
- Research Laboratory of Hepatobiliary Diseases General Surgical Department, The Second Xiangya Hospital, Central South University, Changsha, China
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Carniol ET, Bresler A, Shaigany K, Svider P, Baredes S, Eloy JA, Ying YLM. Traumatic Tympanic Membrane Perforations Diagnosed in Emergency Departments. JAMA Otolaryngol Head Neck Surg 2019; 144:136-139. [PMID: 29270620 DOI: 10.1001/jamaoto.2017.2550] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Tympanic membrane perforations (TMPs) are frequent events leading to evaluation in the primary care and otolaryngology offices or the emergency department (ED). Despite specific warning labels on packaging of cotton-tipped applicators regarding the risk of injury to the ear canal with personal use, these products are commonly used to remove ear cerumen. Objective To analyze the mechanism of injury for traumatic TMPs among patients presenting to the ED. Design, Setting, and Participants Cross-sectional analysis of cases from 100 emergency departments in the United States. The National Electronic Injury Surveillance System was searched on April 3, 2015, for ear-related injuries with analysis information regarding patient age, patient sex, time and date of injury, specific injury diagnoses, and specific injury mechanisms that occurred across 5 years, from January 1, 2010, through December 31, 2014. Main Outcomes and Measures Diagnoses of traumatic TMP documented in the ED visit record as well as patient demographics, diagnoses, and other aspects of the injury, including mechanism of injury. Results There were 949 case entries in the database for traumatic TMP, which extrapolates to 4852 ED visits nationally. Of 949 patients evaluated, 568 (59.8%) were men and 381 (40.2%) were women resulting in a male to female ratio of 1.49:1. Most injuries occurred in patients 18 years or younger (602 of 949 [63.4%]) with children younger than 6 years most at risk (331 of 949 [34.9%]). Ear canal instrumentation including foreign bodies was noted in 581 of 949 cases (61.2%), with cotton-tipped applicators noted in 261 (44.9%) of these cases. While foreign body instrumentation represented the leading cause of traumatic TMP in patients aged 0 to 5 years (284 of 331 cases [85.8%]), 6 to 12 years (108 of 158 [68.4%]), 19 to 36 years (85 of 223 [38.1%]), 37 to 54 years (48 of 91 [52.7%]), and 55 years or older (22 of 33 [66.7%]), water trauma was the leading cause of TMP in patients aged 13 to 18 years (43 of 113 cases [38.1%]). Conclusions and Relevance Traumatic TMP represents a common reason for evaluation in the ED. Despite common warnings regarding risk of injury to the tympanic membrane with use of a cotton-tipped applicator, it is still a major cause of traumatic TMPs. Other injury mechanisms also play an important role in the teenage and young adult populations.
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Affiliation(s)
- Eric T Carniol
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Amishav Bresler
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
| | - Kevin Shaigany
- Department of Otolaryngology-Head and Neck Surgery, University of Maryland, Baltimore
| | - Peter Svider
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
| | - Soly Baredes
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
| | - Yu-Lan Mary Ying
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
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Ungar OJ, Shilo S, Anat W, Cavel O, Handzel O, Oron Y. Blast-Induced Cholesteatomas After Spontaneous Tympanic Membrane Healing. Ann Otol Rhinol Laryngol 2019; 128:1147-1151. [PMID: 31366214 DOI: 10.1177/0003489419865568] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To characterize blast-induced cholesteatomas (BIC) in terms of symptoms, presentation, and location within the middle ear cleft (MEC). DESIGN A search for all English language articles in "MEDLINE" via "PubMed" and "Google Scholar" was conducted. RESULTS A total of 67 ears with BIC were included. Fifty-eight ears in which the traumatic perforation failed to spontaneously close were excluded, leaving seven case reports (eight patients, nine ears) for statistical analysis. Time between blast exposure to spontaneous tympanic membrane (TM) closure was 16 days to 10 months. Time between blast exposure and cholesteatoma diagnosis was 5 months to 4 years. The cholesteatomas were diagnosed due to symptoms in two ears, as asymptomatic finding on physical examination in one ear and as asymptomatic finding in axial imaging in three ears. CONCLUSIONS BICs can develop behind intact tympanic membrane or along with TM perforation. Based on the current review, when a TM perforation and spontaneous healing were documented, after blast exposure, MRI scan is an integral component of the follow-up. The optimal timing for MRI performance after blast exposure, is yet to be identified.
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Affiliation(s)
- Omer J Ungar
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Shahaf Shilo
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Wengier Anat
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Oren Cavel
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
| | - Yahav Oron
- Department of Otolaryngology-Head and Neck Surgery and Maxillofacial Surgery, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.,Sackler School of Medicine. Tel-Aviv University, Tel-Aviv, Israel
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The effect of epidermal growth factor on the pseudo-healing of traumatic tympanic membrane perforations. Braz J Otorhinolaryngol 2019; 87:53-58. [PMID: 31395492 PMCID: PMC9422542 DOI: 10.1016/j.bjorl.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/28/2019] [Accepted: 06/22/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Traumatic tympanic membrane perforations tend to heal spontaneously. However, in this study, several perforations exhibited abnormal healing, where the morphology of healing tympanic membranes differed from that of non-perforated tympanic membranes. Pseudo-healing of the tympanic membrane was characterized by the accumulation of thickened tissue in the perforated area. OBJECTIVE The purpose of this study was to evaluate the utility of epidermal growth factor in cases showing pseudo-healing of traumatic tympanic membrane perforations. METHODS A total of 26 traumatic tympanic membrane perforations showing pseudo-healing were included in this study. In all cases, tissue that accumulated in the perforated area was removed, which subsequently caused a new perforation to form. An epidermal growth factor solution was applied to the tympanic membrane once daily to keep the tympanic membrane moist. Closure rates and times were evaluated at 6 months. RESULTS During the 6 months follow-up period, two patients were lost. Of the remaining 24 patients, the closure rate was 100% (24/24) and the closure time was 6.1 ± 2.3 days (range: 3-12 days). The morphology of the healed tympanic membrane was not significantly different from that of the remnant tympanic membrane. CONCLUSIONS Pseudo-healing of traumatic tympanic membrane perforations affects sound conduction. This can be associated with various symptoms, including tinnitus, aural fullness, and ear discomfort. The excision of excessive epithelial tissue and topical application of epidermal growth factor can correct the pseudo-healing of traumatic tympanic membrane perforations.
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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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Comparative study of epidermal growth factor and observation only on human subacute tympanic membrane perforation. Am J Otolaryngol 2019; 40:209-212. [PMID: 30554883 DOI: 10.1016/j.amjoto.2018.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/21/2018] [Accepted: 11/27/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the effects of epidermal growth factor (EGF) and observation only on human subacute tympanic membrane perforation (TMP). METHODS A total of 44 patients with traumatic TMPs >2 months after trauma were divided into an observation group (n = 18) and EGF group (n = 26). Patients in the EGF group underwent direct application of EGF without stripping of the perforation edge. All patients were followed up for at least 6 months. The TMP closure rate, closure time, and hearing gain were evaluated. RESULTS At 6 months, 25 of 26 (96.2%) perforations achieved complete closure with a mean closure time of 9.1 ± 3.9 days (range, 3-14 days) in the EGF group. However, only 11 of 18 (61.1%) perforations achieved complete closure in the observation group, with a mean closure time of 20.6 ± 10.7 days (range = 9-71 days). The patients in the EGF-treated group had significantly improved closure rates (P = 0.026) and a reduced closure time (P < 0.01) compared to those in the observation group. The difference in mean hearing improvement between the two groups was not statistically significant (P = 0.86). CONCLUSIONS Topical application of EGF improved the closure rate and shortened the closure time of human subacute TMPs compared with spontaneous healing, the stripping of the perforation edge was unnecessary. This treatment is simple and convenient and should be recommended pre-myringoplasty.
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Zheng-Cai L, Zi-Han L. The short- and long-term adverse effects of FGF-2 on tympanic membrane perforations. ACTA ACUST UNITED AC 2019; 38:264-272. [PMID: 29984804 DOI: 10.14639/0392-100x-1480] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 12/18/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY The objective of this study was to investigate the short- and long-term adverse effects of fibroblast growth factor-2 treatment of tympanic membrane perforations. A total of 134 patients with traumatic tympanic membrane perforations were randomly divided into two groups: an observational group and a fibroblast growth factor-2 treatment group. The closure rate, closure time and principal side-effects were compared between the groups at 6 and 12 months. At 6 months, 131 patients were examined to determine healing outcomes and short-term side-effects. The total closure rate differed significantly between the fibroblast growth factor-2 and observational groups (95.5% vs 73.4, p #x003C; 0.01). The fibroblast growth factor-treated group exhibited a significantly shorter closure time than the observational group (11.9±3.1 days vs 52.6 ± 18.1 days, p = 0.00). Three patients with secondary otitis media with effusion, and three with reperforations, were noted in the fibroblast growth factor-2 group. We additionally performed long-term follow-up on 89.1% of the patients in the observational group and 92.5% of the patients in the fibroblast growth factor-2 group; follow-up was performed 16-42 months after perforation closure. Only a small perforation of the pars flaccida developed in the fibroblast growth factor-2 group. No middle ear cholesteatoma was noted in either group. This study suggests that the topical application of fibroblast growth factor-2 to human traumatic tympanic membranes is safe. Otorrhoea was the most common short-term side-effect; other less common side-effects included otitis media with effusion and reperforation. No serious long-term side-effects were found.
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Affiliation(s)
- L Zheng-Cai
- Department of Otolaryngology, the affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu City, Zhejiang Provice, China
| | - L Zi-Han
- Department of Clinical Medicine, Xinxiang Medical University, Xinxiang City, Henan Provice, China
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Sogebi OA, Oyewole EA, Mabifah TO. Traumatic tympanic membrane perforations: characteristics and factors affecting outcome. Ghana Med J 2018; 52:34-40. [PMID: 30013259 DOI: 10.4314/gmj.v52i1.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To characterize traumatic tympanic membrane perforation (TTMP) in terms of distribution, mechanisms, and outcome of treatment. To assess the factors influencing such outcome. Study design Prospective analytical study, assessing outcomes post-injuries. Setting Clinical department of a tertiary referral hospital. Participants Patients with TTMP based on history of trauma to the ear, and otoscopic examination confirming tympanic membrane (TM) perforation. Interventions Conservative, inactive treatment. Main Outcome Measures Distribution and healing of perforations. Results There were 53 patients, Male: Female ratio =1.5:1, age 8-71years (Mean ±SD= 33.8 ±12.9). Median duration of injury before presentation was 3 days. 11 patients had both ears traumatized. 46.9% of perforations were in the antero-inferior part of the TM. Median size of perforations was 33.0%; Patients main complaints were blockage of the ears/ hearing loss and tinnitus. Common causes of perforations were domestic assault (28.3%), self-inflicted/ accidental injuries (20.8%), and road traffic accidents (18.9%). There was a significant difference in the mechanism/cause of injuries between the sexes (X2 =15.607, p=0.005). Traumatic perforation was caused by penetrating injuries in 22 (34.4%) ears. The outcome of TTMP was poor in 18.7%. Big sized perforations (t=2.630; p=0.011), penetrating injuries (X2 =9.263; p=0.005), and postero-superior location (X2=6.326;p=0.009) had negative impacts on the healing. Conclusions TTMP was common in young adult males, caused often by assaults, presented with ear hearing loss and tinnitus, perforations were located in antero-inferior part of TM and most healed well. Factors associated with poor healing were postero-superior location, large size and penetrating injuries to the TM. Funding Not indicated.
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Affiliation(s)
- Olusola A Sogebi
- Department of Ear Nose and Throat, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Emmanuel A Oyewole
- Department of Ear Nose and Throat, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | - Taofeeq O Mabifah
- Department of Ear Nose and Throat, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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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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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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Smart D. Ruptured tympanic membrane from underwater impact with an Atlantic salmon, Salmo salar. Diving Hyperb Med 2017; 47:201-202. [PMID: 28868602 DOI: 10.28920/dhm47.3.201-202] [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: 07/10/2017] [Accepted: 07/10/2017] [Indexed: 11/05/2022]
Abstract
An unusual case of tympanic membrane rupture in a diver due to impact from an Atlantic salmon, Salmo salar is described. The diver was treated conservatively and the injury fully healed by eight weeks after which the diver successfully returned to diving. The author contends that the appearances of such traumatic perforations differ from barotrauma in divers secondary to ear clearing problems on descent.
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Affiliation(s)
- David Smart
- Department of Diving and Hyperbaric Medicine, Royal Hobart Hospital and School of Medicine, and Faculty of Health Sciences, University of Tasmania, GPO Box 1061, Hobart, Tasmania 7001, Australia,
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Jiang Z, Lou Z. Comparing the outcome of tympanoplasties using bovine pericardium underlay xenografts versus butterfly inlay autografts. Eur Arch Otorhinolaryngol 2017; 274:3535-3537. [DOI: 10.1007/s00405-016-4374-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 11/04/2016] [Indexed: 11/28/2022]
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Jin ZH, Dong YH, Lou ZH. The effects of fibroblast growth factor-2 delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic eardrum perforations lying close to the malleus. Am J Otolaryngol 2017; 38:582-587. [PMID: 28606657 DOI: 10.1016/j.amjoto.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/17/2017] [Accepted: 06/04/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus. STUDY DESIGN A prospective, randomized, controlled clinical study. SETTING A university-affiliated teaching hospital. SUBJECTS AND METHODS We prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting >25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only. RESULTS We analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p<0.05).The mean closure times were 15.7±5.1, 24.8±4.9, and 35.7±9.2days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p<0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group. CONCLUSIONS FGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings.
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Affiliation(s)
- Zhong-Hai Jin
- Department of Medicine, YiWu Central Hospital, Yiwu city 322000, Zhejiang Province, China
| | - Yi-Han Dong
- Department of Otolaryngology, Daqing Oilfield Genaral Hospital, Daqing City 163001, Heilongjiang Province, China
| | - Zi-Han Lou
- Department of Clinical Medicine, Xinxiang Medical University, Xinxiang City 453003, Henan Province, China.
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Effectiveness of patching traumatic eardrum perforations with lens cleaning paper via an otoscope. J Laryngol Otol 2017; 131:805-808. [DOI: 10.1017/s0022215117001426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:To study the clinical effect of lens cleaning paper patching on traumatic eardrum perforations.Methods:A total of 122 patients were divided into 2 groups, of which 56 patients were treated with lens cleaning paper patching and 66 acted as controls. The closure rate and healing time were compared between the two groups.Results:The healing rate of small perforations was 96.4 per cent (27 out of 28) in the patching group and 90 per cent (27 out of 30) in the control group. The difference was not statistically significant (p > 0.05). The healing rate of large perforations was 89.3 per cent (25 out of 28) and 80.6 per cent (29 out of 36) in the two groups, respectively. The difference was statistically significant (p < 0.05). The healing time of large perforations was shorter in the patching group than in the control group (p < 0.01).Conclusion:Patching with lens cleaning paper under an endoscope can accelerate the closure of large traumatic eardrum perforations.
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Jin ZH, Lou ZH, Lou ZC. Assessment and spontaneous healing outcomes of traumatic eardrum perforation with bleeding. Am J Otolaryngol 2017; 38:479-483. [PMID: 28479299 DOI: 10.1016/j.amjoto.2017.04.014] [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: 01/31/2017] [Revised: 04/06/2017] [Accepted: 04/09/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study investigated the influence of the degree of bleeding from the remnant eardrum on the spontaneous healing of human traumatic tympanic membrane perforations (TMPs). STUDY DESIGN A case series with chart review. SETTING A tertiary university hospital. MATERIALS AND METHODS The clinical records of traumatic TMP patients who met the case selection criteria were retrieved and categorized into two groups based on the documented degree of bleeding from the remnant eardrum: with and without bleeding. The demographic data and spontaneous healing outcomes (i.e., healing rate and duration) of these two TMP types were analyzed using the chi-squared test or t-test. RESULTS One-hundred and eighty-eight cases met the inclusion criteria and were analyzed. Of these, 58.5% had perforations without bleeding and the remaining 41.5% had perforations with bleeding. The overall closure rate at the end of the 3-month follow-up period was 90.9% for perforations without bleeding and 96.2% for perforations with bleeding; the difference was not statistically significant (P>0.05). However, the average closure time differed significantly between the two groups (P<0.05): 29.4±3.7days for perforations without bleeding and 20.6±9.2days for perforations with bleeding. The closure rate was significantly different between the groups (62 vs. 15.6%, P<0.01) within 2weeks for medium-sized perforations. In total, 11 (39.3%) large-sized perforations achieved complete closure in the group with bleeding, while none of the large-sized perforations closed in the group without bleeding within 2weeks. The closure rate of medium-sized perforations was not significantly different (79.2 vs. 92%, P>0.05) between the groups without and with bleeding within 4weeks, while the closure rate of large-sized perforations was significantly different between the groups without and with bleeding (27.2 vs. 75%, P=0.0). CONCLUSION This study shows that traumatic TMPs with bleeding significantly shortened the closure time compared to TMPs without bleeding. This finding indicates a significant correlation between the prognosis of traumatic TMPs and the degree of eardrum bleeding: severe bleeding from and a hematoma in the remnant eardrum appear to be good signs.
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Lou Z, Lou Z. A comparative study to evaluate the efficacy of EGF, FGF-2, and 0.3% (w/v) ofloxacin drops on eardrum regeneration. Medicine (Baltimore) 2017; 96:e7654. [PMID: 28746231 PMCID: PMC5627857 DOI: 10.1097/md.0000000000007654] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 07/11/2017] [Accepted: 07/11/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Traumatic tympanic membrane perforations (TMPs) tend to spontaneous healing, however, large TMPs usually fail to healing. Clinical and experimental studies had demonstrated that growth factors accelerated the healing of large TMPs. The aim of this study was to compare the effects of growth factors and 0.3% (w/v) ofloxacin drops n the healing of human large TMPs. METHODS A total of 184 human large traumatic TMPs were randomly assigned to receive epidermal growth factor (EGF) treatment, fibroblast growth factor-2 (FGF-2) treatment, 0.3% (w/v) ofloxacin drops treatment, and conservative observation (only). RESULTS A total of 180 patients were analyzed in this study at the 6-month follow-up. The closure rates of the perforations in the EGF, FGF-2, 0.3% (w/v) ofloxacin drops, and conservative observation groups were 91.11%, 93.18%, 95.65%, and 82.22%, respectively, the closure rates did not significantly differ among the groups (P = .165). Similarly, pairwise comparisons did not reveal any significant between-group differences (P > .0083). However, the difference of the mean closure time was significant among the 4 groups (P < .001), pairwise comparisons showed that closure time was significantly longer in the observational group than in the other 3 groups (P < .001). Nevertheless, no significant difference in mean closure time was evident between any 2 treated groups (P > .0083). The mean hearing gain after 6 months was 11.49 ± 5.88 dB for the EGF group, 10.89 ± 5.16 dB for the FGF-2 group, 10.54 ± 5.56 dB for the ofloxacin group, and 9.29 ± 5.36 dB for the observation group. Differences in hearing improvement rates among the 4 groups were not statistically significant (P = .283). CONCLUSION Epidermal growth factor, FGF-2, and 0.3% (w/v) ofloxacin drops accelerated the closure of large TMPs compared with conservative treatment. Surprisingly, neither the closure rate nor closure time differed significantly among the 3 treated groups. Further experimental studies to demonstrate whether 0.3% (w/v) ofloxacin per se accelerates the healing of TMPs will be interesting in the future.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, The Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, Zhejiang
| | - Zihan Lou
- Department of Clinical Medicine, Xinxiang Medical University, Xinxiang, Henan, China
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A moist edge environment aids the regeneration of traumatic tympanic membrane perforations. The Journal of Laryngology & Otology 2017; 131:564-571. [PMID: 28502255 DOI: 10.1017/s0022215117001001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To review the history of moist therapy used to regenerate traumatic tympanic membrane perforations. STUDY DESIGN Literature review. METHODS The literature on topical agents used to treat traumatic tympanic membrane perforations was reviewed, and the advantages and disadvantages of moist therapy were analysed. RESULTS A total of 76 studies were included in the analysis. Topical applications of certain agents (e.g. growth factors, Ofloxacin Otic Solution, and insulin solutions) to the moist edges of traumatic tympanic membrane perforations shortened closure times and improved closure rates. CONCLUSION Dry tympanic membrane perforation edges may be associated with crust formation and centrifugal migration, delaying perforation closure. On the contrary, moist edges inhibit necrosis at the perforation margins, stimulate proliferation of granulation tissue and aid eardrum healing. Thus, moist perforation margins upon topical application of solutions of appropriate agents aid the regeneration of traumatic tympanic membrane perforations.
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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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Xudan-Lou. Letter to the editor: A retrospective study of EGF and ofloxacin drops in the healing of human large traumatic eardrum perforation. Am J Otolaryngol 2017; 38:266. [PMID: 27964889 DOI: 10.1016/j.amjoto.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/06/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Xudan-Lou
- Department of Otorhinolaryngology Operating Theatre (OR), Yiwu Central Hospital, Yiwu City, Zhejiang Provice 322000, China.
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Jian-Yang. The need for a better indicator of when FGF-2 should be applied to treat subacute tympanic membrane perforations. Am J Otolaryngol 2017; 38:112-113. [PMID: 27773562 DOI: 10.1016/j.amjoto.2016.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/07/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Jian-Yang
- Department of Otorhinolaryngology, YiWu Central Hospital, Zhejiang, China.
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Lou Z. How to manage the traumatic tympanic membrane perforations is best. Acta Otolaryngol 2017; 137:111-112. [PMID: 27546379 DOI: 10.1080/00016489.2016.1217428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Zhengcai Lou
- a Department of Otorhinolaryngology , The Affiliated YiWu Hospital of Wenzhou Medical University , Zhejiang , PR China
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Gür ÖE, Ensari N, Boztepe OF. The advantages of platelet-rich fibrin membrane in the treatment of traumatic tympanic membrane perforations. Acta Otolaryngol 2017; 137:44-46. [PMID: 27546584 DOI: 10.1080/00016489.2016.1217563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lou ZC. The eardrum bridge of traumatic tympanic membrane perforation. Eur Arch Otorhinolaryngol 2016; 273:4653-4654. [PMID: 27509896 DOI: 10.1007/s00405-016-4245-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Zheng-Cai Lou
- The Affiliated Yiwu Hospital of Wenzhou Medical University, 699, Jiangdong Road, Yiwu, 322000, Zhenjiang, China.
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Authors' reply. The Journal of Laryngology & Otology 2016; 130:412-3. [PMID: 27447014 DOI: 10.1017/s0022215116000797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Lee JH, Lee JS, Kim DK, Park CH, Lee HR. In Reply: Treatment for Acute Tympanic Membrane Perforation. Clin Exp Otorhinolaryngol 2016; 9:386. [PMID: 27416734 PMCID: PMC5115153 DOI: 10.21053/ceo.2016.00850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 06/25/2016] [Indexed: 12/02/2022] Open
Affiliation(s)
- Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Chuncheon, Korea
| | - Joong Seob Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Chuncheon, Korea
| | - Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Chuncheon, Korea
| | - Chan Hum Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.,Nano-Bio Regenerative Medical Institute, Hallym University, Chuncheon, Korea
| | - Hae Ran Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Yang J, Lou ZC. Treatment for Acute Tympanic Membrane Perforation. Clin Exp Otorhinolaryngol 2016; 9:284-5. [PMID: 27416737 PMCID: PMC4996108 DOI: 10.21053/ceo.2015.01921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jian Yang
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, China
| | - Zheng-Cai Lou
- Department of Otolaryngology-Head and Neck Surgery, Affiliated Yiwu Hospital of Wenzhou Medical University, Yiwu, China
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