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Patel H, Pavlichenko I, Grinthal A, Zhang CT, Alvarenga J, Kreder MJ, Weaver JC, Ji Q, Ling CWF, Choy J, Li Z, Black NL, Bispo PJM, Lewis JA, Kozin ED, Aizenberg J, Remenschneider AK. Design of medical tympanostomy conduits with selective fluid transport properties. Sci Transl Med 2023; 15:eadd9779. [PMID: 37018418 DOI: 10.1126/scitranslmed.add9779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Implantable tubes, shunts, and other medical conduits are crucial for treating a wide range of conditions from ears and eyes to brain and liver but often impose serious risks of device infection, obstruction, migration, unreliable function, and tissue damage. Efforts to alleviate these complications remain at an impasse because of fundamentally conflicting design requirements: Millimeter-scale size is required to minimize invasiveness but exacerbates occlusion and malfunction. Here, we present a rational design strategy that reconciles these trade-offs in an implantable tube that is even smaller than the current standard of care. Using tympanostomy tubes (ear tubes) as an exemplary case, we developed an iterative screening algorithm and show how unique curved lumen geometries of the liquid-infused conduit can be designed to co-optimize drug delivery, effusion drainage, water resistance, and biocontamination/ingrowth prevention in a single subcapillary-length-scale device. Through extensive in vitro studies, we demonstrate that the engineered tubes enabled selective uni- and bidirectional fluid transport; nearly eliminated adhesion and growth of common pathogenic bacteria, blood, and cells; and prevented tissue ingrowth. The engineered tubes also enabled complete eardrum healing and hearing preservation and exhibited more efficient and rapid antibiotic delivery to the middle ear in healthy chinchillas compared with current tympanostomy tubes, without resulting in ototoxicity at up to 24 weeks. The design principle and optimization algorithm presented here may enable tubes to be customized for a wide range of patient needs.
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Affiliation(s)
- Haritosh Patel
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Ida Pavlichenko
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Alison Grinthal
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
| | - Cathy T Zhang
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
| | - Jack Alvarenga
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Michael J Kreder
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
| | - James C Weaver
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Qin Ji
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Christopher W F Ling
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Joseph Choy
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Zihan Li
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Nicole L Black
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Paulo J M Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, MA 02114, USA
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
| | - Jennifer A Lewis
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
| | - Elliott D Kozin
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
| | - Joanna Aizenberg
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Boston, MA 02134, USA
- Wyss Institute for Biologically Inspired Engineering, Harvard University, Boston, MA 02115, USA
- Department of Chemistry and Chemical Biology, Harvard University, Cambridge, MA 02138, USA
| | - Aaron K Remenschneider
- Harvard Medical School, Harvard University, Boston, MA 02115, USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA 02114, USA
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Cofer S, Meyer A, Yoon D, Beebe D, Castro C, Rimell F, Belani K. Tympanostomy Tube Placement in Children Using a Single-Pass Tool with Moderate Sedation. Otolaryngol Head Neck Surg 2017; 157:533-535. [DOI: 10.1177/0194599817707178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Insertion of tympanostomy tubes is a common elective pediatric surgical procedure and is typically performed under general anesthesia. The potential to reduce general anesthetic requirements for young children has led to increased interest in alternatives for tympanostomy tube placement. A tympanostomy tube system, developed to enable tympanostomy tube placement in a single pass on conscious patients under moderate sedation, was evaluated. A prospective study on 128 children and 253 tympanostomy tube placements conducted at 4 centers in the United States demonstrated an 88.3% success rate in performing the procedure under moderate sedation with adverse events within normal rates reported in the literature. The feasibility of completing tympanostomy tube placement under moderate sedation enables avoidance of general anesthesia and provides additional choices to physicians and parents.
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Affiliation(s)
- Shelagh Cofer
- Department of Otorhinolaryngology, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Abby Meyer
- Pediatric ENT and Facial Plastic Surgery, Children’s Hospital and Clinics of Minnesota, Minneapolis, Minnesota, USA
- Department of Otorhinolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel Yoon
- Fairview Health Services, Minneapolis, Minnesota, USA
| | - David Beebe
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chandra Castro
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Frank Rimell
- Pediatric ENT and Facial Plastic Surgery, Children’s Hospital and Clinics of Minnesota, Minneapolis, Minnesota, USA
- Department of Otorhinolaryngology, University of Minnesota, Minneapolis, Minnesota, USA
- Preceptis Medical, Inc, Plymouth, Minnesota
| | - Kumar Belani
- Department of Anesthesiology, University of Minnesota, Minneapolis, Minnesota, USA
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