Traumatic perforations of the tympanic membrane: early closure with paper tape patching

3D Bioprinting in Otolaryngology: A Review

The evolution of tissue engineering and 3D bioprinting has allowed for increased opportunities to generate musculoskeletal tissue grafts that can enhance functional and aesthetic outcomes in otolaryngology-head and neck surgery. Despite literature reporting successes in the fabrication of cartilage and bone scaffolds for applications in the head and neck, the full potential of this technology has yet to be realized. Otolaryngology as a field has always been at the forefront of new advancements and technology and is well poised to spearhead clinical application of these engineered tissues. In this review, current 3D bioprinting methods are described and an overview of potential cell types, bioinks, and bioactive factors available for musculoskeletal engineering using this technology is presented. The otologic, nasal, tracheal, and craniofacial bone applications of 3D bioprinting with a focus on engineered graft implantation in animal models to highlight the status of functional outcomes in vivo; a necessary step to future clinical translation are reviewed. Continued multidisciplinary efforts between material chemistry, biological sciences, and otolaryngologists will play a key role in the translation of engineered, 3D bioprinted constructs for head and neck surgery.

Thymosin beta-4 - A potential tool in healing middle ear lesions in adult mammals

Acute tympanic membrane perforations primarily occur due to injury or infection in humans. In acute cases, nearly 80-94 % of the perforations heal spontaneously. In chronic cases, non-surgical treatment becomes significantly limited, and the perforation can be restored only by myringoplasty. In addition to classical grafts such as the fascia or cartilage, promising results have been reported with various biological materials including silk or acellular collagen. However, despite of all the efforts, healing remains insufficient. Consequentially, a need for substances which actively promote tympanic cell migration and proliferation is deemed essential. In our study, we utilized Thymosin beta-4 (TB4), a 43aa peptide possessing many regenerative properties in various organ systems. Our aim was to reveal the impact of externally administered TB4 regarding impairments of the middle ear, particularly the tympanic membrane. We harvested tympanic membranes from adult mice and treated these with TB4 or PBS on both collagen gel matrixes and in the form of floating, ex vivo explants. Cell migration and proliferation was measured, while immunocytochemical analyses were performed to determine cell type and the nature of the targeted molecules. We discovered the peptide affects the behavior of epidermal and epithelial cells of the tympanic membrane in vitro. Moreover, as our initial results imply, it is not the differentiated, yet most likely the local epidermal progenitor cells which are the primary targets of the molecule. Our present results unveil a new, thus far undiscovered field regarding clinical utilization for TB4 in the future.

To patch or not to patch acute isolated traumatic tympanic membrane perforations: a case series and systematic literature review

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.

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

OBJECTIVES

Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans.

METHODS

A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed.

RESULTS

The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small-intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air-bone gap of 5.6 dB was found in the 23% of studies reporting this metric.

CONCLUSIONS

The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392-400, 2021.

The effects of everted or inverted edges on healing of traumatic-induced tympanic membrane perforations

Objectives

To evaluate the healing and hearing outcomes related to the everted or inverted edge area on slap- and fist-induced large tympanic membrane perforations.

Methods

A 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.

Results

The 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).

Conclusion

The 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.

Traumatic perforations of the tympanic membrane: immediate clinical recovery with the use of bacterial cellulose film

Introduction

Perforation of the tympanic membrane is a reasonably frequent diagnosis in otorhinolaryngologists’ offices. The expectant management is to wait for spontaneous healing, which usually occurs in almost all cases in a few weeks. However, while waiting for healing to be completed, the patients may experience uncomfortable symptoms. Although some research suggests the use of various materials to aid in the recovery of the tympanic membrane, none presented robust evidence of improvement in the cicatricial process. Nevertheless, the occlusion of the perforation with some material of specific texture and resistance can alleviate the patients’ symptoms and accelerate the healing process.

Objective

To evaluate the clinical (symptomatic and functional) improvement after the placement of bacterial cellulose film (Bionext®) on tympanic membrane perforations (traumatic).

Methods

We evaluated 24 patients, victims of traumatic perforations of the tympanic membrane, who were evaluated in the Otorhinolaryngology Emergency Room. Following otoscopy and audiometric examination was performed, before and after the use of cellulose film occluding the tympanic membrane perforation.

Results

Twenty-four patients were included, whose degree of overall discomfort caused by the tympanic membrane perforation and the presence of symptoms of autophonia, ear fullness and tinnitus were investigated. The mean score attributed to the overall annoyance caused by tympanic membrane perforation was 7.79, decreasing to a mean value of 2.25 after the film application. Symptom evaluation also showed improvement after using the film: autophonia decreased from a mean value of 6.25 to 2.08, tinnitus from 7 to 1.92 and ear fullness from 7.29 to 1.96. The auditory analysis showed mean threshold values still within the normal range at low and medium frequencies, with slight hearing loss at acute frequencies, but with significant improvement at all frequencies, with the exception of 8000 Hz, after film use.

Conclusion

The use of bacterial cellulose film fragment on traumatic perforations of the tympanic membrane promoted immediate functional and symptomatic recovery in the assessed patients.

Pretreatment factors affecting traumatic tympanic membrane regeneration therapy using epidermal growth factor

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.

Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations

Introduction

In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic.

Objective

This study evaluated the healing response for different repair patterns in human traumatic tympanic membrane perforations by endoscopic observation.

Methods

In total, 114 patients with traumatic tympanic membrane perforations were allocated sequentially to two groups: the spontaneous healing group (n = 57) and Gelfoam patch-treated group (n = 57). The closure rate, closure time, and rate of otorrhea were compared between the groups at 3 months.

Results

Ultimately, 107 patients were analyzed in the two groups (52 patients in the spontaneous healing group vs. 55 patients in the Gelfoam patch-treated group). The overall closure rate at the end of the 3 month follow-up period was 90.4% in the spontaneous healing group and 94.5% in the Gelfoam patch-treated group; the difference was not statistically significant (p > 0.05). However, the total average closure time was significantly different between the two groups (26.8 ± 9.1 days in the spontaneous healing group vs. 14.7 ± 9.1 days in the Gelfoam patch-treated group, p < 0.01). In addition, the closure rate was not significantly different between the spontaneous healing group and Gelfoam patch-treated group regardless of the perforation size. The closure time in the Gelfoam patch-treated group was significantly shorter than that in the spontaneous healing group regardless of the perforation size (small perforations: 7.1 ± 1.6 days vs. 12.6 ± 3.9, medium-sized perforations: 13.3 ± 2.2 days vs. 21.8 ± 4.2 days, and large perforations: 21.2 ± 4.7 days vs. 38.4 ± 5.7 days; p < 0.01).

Conclusion

In the regeneration of traumatic tympanic membrane perforations, Gelfoam patching not only plays a scaffolding role for epithelial migration, it also promotes edema and hyperplasia of granulation tissue at the edges of the perforation and accelerates eardrum healing.

Efficacy of EGF and Gelatin Sponge for Traumatic Tympanic Membrane Perforations: A Randomized Controlled Study

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.

Chitosan/PEI patch releasing EGF and the EGFR gene for the regeneration of the tympanic membrane after perforation

EGF and EGFR gene-releasing PEI/chitosan patch (EErP-CPs) was developed to increase the regeneration of tympanic membrane perforations.

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations

Introduction

Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial.

Objective

We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations.

Methods

The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30° and 70° endoscopes.

Results

In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period.

Conclusion

This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30° and 70° endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

Analysis of Effect of Eggshell Membrane Patching for Moderate-to-Large Traumatic Tympanic Membrane Perforation

Background and Objectives

To evaluate the effect of eggshell membrane (ESM) patching for tympanic membrane (TM) perforation, and to investigate correlations between healing time and age, gender, patching time, perforation size, and perforation location.

Subjects and Methods

One hundred and seventy-five patients diagnosed with traumatic TM perforation at the Department of Otorhinolaryngology-Head and Neck Surgery, Korea University Ansan Hospital, between January 2008 and October 2013. Patients were divided into two groups, according to perforation edge approximation or ESM patching treatment. Healing time was compared between the group that received perforation edge approximation and the group that received ESM patching. Perforation grade, age, onset, and location were also compared between the two groups.

Results

ESM patching significantly improved healing time compared to spontaneous healing, especially in patients with moderate or large traumatic TM perforations (≥grade II). However, patient age, gender, perforation location, and especially timing of procedure, did not significantly affect healing time.

Conclusions

ESM patching can be a good treatment choice to promote tympanic membrane healing in large traumatic TM perforations.

Mesenchymal stem cell-laden hybrid scaffold for regenerating subacute tympanic membrane perforation

Tympanic membrane (TM) perforation is one of the most common otology complications. To date, there has not been reported TM regeneration using bioprinted scaffold. The purpose of this study was to evaluate the efficacy and feasibility of bioprinted polycaprolactone/collagen/alginate-mesenchymal stem cell (PCAMSC) scaffolds for the regeneration of subacute TM perforation. Sprague-Dawley rats were used in an animal model of subacute TM perforation. In the experimental group (n=7), bioprinted 3D PCAMSC scaffold was placed on the perforation. The control group (n=7) were treated with polycaprolactone/collagen/alginate (PCA) scaffold. Healing time, acoustic-mechanical properties, and morphological analysis were performed by otoendoscopy, auditory brainstem response (ABR), single-point laser doppler vibrometer (LDV), optical coherence tomography (OCT), and light microscopic evaluation. The closure of the TM perforation was achieved in 100% of the experimental group vs. 72% of the control group, and this difference was statistically significant (p<0.05). The ABR threshold at all frequencies of the experimental group was recovered to the normal level compared to the control group. TM vibration velocity in the experimental group recovered similar to the normal control level. The difference are very small and they are not statistically significant below 1kHz (p=0.074). By OCT and light microscopic examination, regenerated TM of the experimental group showed thickened fibrous and mucosal layer. In contrast, the control group showed well regenerated but less thickened than experimental group. From these results, the cell-laden PCAMSC scaffold offers a significant advantage in the TM regeneration in a rat subacute TM perforation model. It may offer attractive opportunities in the conservative clinical treatment.

Acceleration of Healing of Traumatic Tympanic Membrane Perforation in Rats by Implanted Collagen Membrane Integrated with Collagen-Binding Basic Fibroblast Growth Factor

Traumatic tympanic membrane (TM) perforation is very common in clinical practice. Several biomaterials have been reported to play a role in TM reparation, whereas their functional recovery is limited when used alone. Meanwhile, the administration of biofactors could promote functional recovery, but rapid distribution and short half-time obstruct their application. To study the effect of traumatic TM regeneration, we prepared collagen membrane (CM) integrated with collagen-binding basic fibroblast growth factor (CBD-bFGF) and implanted into the injury site of perforated TM in Sprague-Dawley rats. The study on CBD-bFGF in vitro showed that CBD-bFGF accelerated the proliferation of human fibroblast cell HS-865 biologically and was released from CM gradually. In vivo study, through the gross anatomy, auditory brainstem responses assay, histological staining, and transmission electron microscopy observation at d7, d14, and d28 after the acute TM perforation, we found that CBD-bFGF-integrated CM promoted the healing rate at an early stage (∼7 days), reduced the healing time of perforated TM, and notably retrieved the structure and hearing of TM. These findings suggest that CM modified with CBD-bFGF could be therapeutically appropriate for the treatment of TM perforation.

Risk factors affecting human traumatic tympanic membrane perforation regeneration therapy using fibroblast growth factor-2

OBJECTIVE

The use of growth factors to achieve closure of human traumatic tympanic membrane perforations (TMPs) has recently been demonstrated. However, pretreatment factors affecting healing outcomes have seldom been discussed. The objective of this study was to evaluate pretreatment factors contributing to the success or failure of healing of TMPs using fibroblast growth factor-2 (FGF-2).

DESIGN AND PARTICIPANTS

A retrospective cohort study of 99 patients (43 males, 56 females) with traumatic TMPs who were observed for at least 6 months after FGF-2 treatment between March 2011 and December 2012. Eleven factors considered likely to affect the outcome of perforation closure were evaluated statistically using univariate and multivariate logistic regression analysis.

INTERVENTIONS

Each traumatic TMP was treated by direct application of FGF-2.

MAIN OUTCOME MEASURES

Complete closure versus failure to close.

RESULTS

In total, 99 patients were analyzed. The total closure rate was 92/99 (92.9%) at 6 months; the mean closure time was 10.59 ±  6.81 days. The closure rate did not significantly differ between perforations with or without inverted edges (100.0% vs. 91.4%, p = 0.087), among different size groups (p = 0.768), or among different periods of exposure to injury (p = 0.051). However, the closure rate was significantly different between the high- and low-dose FGF-2 groups (85.0% vs. 98.3%, p = 0.010) and between perforations where the umbo or malleus was or was not involved in perforation (85.4% vs. 98.3%, p = 0.012). Additionally, univariate logistic regression analysis tests showed that it was difficult to achieve healing of these perforations with a history of chronic otitis media or residual TM calcification (p = 0.006), the umbo or malleus was involved in perforation (p = 0.038), and with a high dose of FGF-2 (p = 0.035) compared with control groups. Multivariate logistic regression analysis showed that only a history of chronic otitis media and residual TM calcification and perforation close to the umbo or malleus were associated with non-healing of the TM perforation (p = 0.03 and p = 0.017, respectively) with relative risk factors.

CONCLUSIONS

Direct application of FGF-2 can be used in all traumatic TMPs, the size of the perforation and inverted edges did not affect the closure rate, and the most beneficial dose was sufficient to keep the residual eardrum environment moist, but without adding liquid. Additionally, multivariate logistic regression analysis revealed that a large perforation was not a major risk factor for nonhealing of TM perforations. However, a history of chronic otitis media, residual TM calcification and involvement of the umbo or malleus in perforation were significant risk factors.

Healing outcomes of large (>50%) traumatic membrane perforations with inverted edges following no intervention, edge approximation and fibroblast growth factor application; a sequential allocation, three-armed trial

OBJECTIVE

The goal of this study was to evaluate the effects of perforation edge approximation and direct application of basic fibroblast growth factor (bFGF) each alone on the healing of large traumatic tympanic membrane perforations with inverted edges in humans.

STUDY DESIGN

Prospective, sequential allocation, three-armed, controlled clinical study.

SETTING

University-affiliated teaching hospital.

PARTICIPANTS

Fifty-eight patients with large traumatic tympanic membrane perforations (i.e. affecting >50% of the surface area) with inverted edges were recruited. They were sequentially allocated to three groups: no intervention (n = 18), edge approximation alone (n = 20) and direct application of bFGF (n = 20). Otoscopy were performed before the treatment and at follow-up visits.

MAIN OUTCOME MEASURES

The closure rate, closure time and rate of otorrhoea.

RESULTS

Application of bFGF yielded a significantly higher average rate of perforation closure (100%) than edge approximation (60%) and no intervention (56%) (P < 0.05). It also significantly shortened the average closure time (12.4 ± 3.6 days) as compared to edge approximation (46.3 ± 8.7 days) and no intervention control (48.2 ± 5.3 days) (P < 0.05). Purulent otorrhoea was observed in none of the three groups.

CONCLUSION

Edge approximation of inverted edges has little benefit in improving the healing outcome of large traumatic tympanic membrane perforations and thus is not an ideal treatment option for large traumatic tympanic membrane perforations. Application of bFGF materially improves the closure rate of large traumatic tympanic membrane perforations and significantly shortens the closure time.

Regeneration of chronic tympanic membrane perforation using 3D collagen with topical umbilical cord serum

Chronic tympanic membrane (TM) perforation is one of the most common otology complications. Current surgical management of TM perforation includes myringoplasty and tympanoplasty. The purpose of this study was to evaluate the efficacy and feasibility of three dimensional (3D) porous collagen scaffolds with topically applied human umbilical cord serum (UCS) for the regeneration of chronic TM perforation in guinea pigs. To achieve this goal, we fabricated porous 3D collagen scaffolds (avg. strut diameter of 236 ± 51 μm, avg. pore size of 382 ± 67 μm, and a porosity of 96%) by using a 3 axis robot dispensing and low temperature plate systems. Guinea pigs were used in a model of chronic TM perforation. In the experimental group (n=10), 3D collagen scaffold was placed on the perforation and topically applied of UCS every other day for a period of 8 days. The control group ears (n=10) were treated with paper discs and phosphate buffered saline (PBS) only using the same regimen. Healing time, acoustic-mechanical properties, and morphological analysis were performed by otoendoscopy, auditory brainstem response (ABR), single-point laser Doppler vibrometer (LDV), optical coherence tomography (OCT), and light microscopic evaluation. The closure of the TM perforation was achieved in 100% of the experimental group vs. 43% of the control group, and this difference was statistically significant (p=0.034). The ABR threshold at all frequencies of the experimental group was significantly recovered to the normal level compared to the control group. TM vibration velocity in the experimental group recovered similar to the normal control level. The difference is very small and they are not statistically significant below 1 kHz (p=0.074). By OCT and light microscopic examination, regenerated TM of the experimental group showed thickened fibrous and mucosal layer. In contrast, the control group showed absence of fibrous layer like a dimeric TM.

Natural evolution of an eardrum bridge in patients with a traumatic eardrum perforation

Although the "eardrum bridge" of traumatic tympanic membrane perforations (TMPs) is very little seen, the underlying natural evolution during the healing process are still unknown.The aim of this retrospective study was to evaluate the natural evolution of the "eardrum bridge" of TMPs. The data for 36 patients with barotrauma-associated traumatic TMPs with an "eardrum bridge" between January 2006 and December 2007 were retrieved. The eardrum bridge was completely liquefied due to infection in one patient. The bridge gradually became necrotic and incorporated into the new eardrum in four patients, and the healed eardrum formed a retraction pocket. In nine patients, epithelial hyperplasia occurred on both sides of the eardrum bridge at the edges, and the bridge became incorporated into the new eardrum, which became very thin over time. However, in 22 patients, the eardrum bridge gradually became necrotic, finally forming a yellow crust-like substance and migrating to the external auditory canal (EAC); it was not incorporated into the new eardrum. The closure of the perforation depended on stratified epithelial migration at the perforation edges near the eardrum bridge, resulting in a normal morphology of the healed eardrum. The present study shows that the eardrum bridge has a different natural evolution during the healing process in patients with a TMP. Most eardrum bridges gradually became necrotic and migrated toward the EAC, and stratified epithelial migration occurred at the perforation edges near the eardrum bridge and closed the perforation. However, a few eardrum bridges gradually became necrotic or developed epithelial hyperplasia, then became incorporated into the new eardrum, resulting in the formation of a retraction pocket and the development of atrophy. Thus, long-term follow-up and histological examination of a larger sample is necessary.

Healing large traumatic eardrum perforations in humans using fibroblast growth factor applied directly or via gelfoam

OBJECTIVE

The goal of this study was to evaluate the effects of conservative treatment and fibroblast growth factor (FGF) applied directly or via Gelfoam on the healing of large traumatic tympanic membrane perforations (TMPs) in humans.

STUDY DESIGN

Prospective, randomized, controlled trial.

METHODS

A randomized prospective analysis was performed between February 2009 and January 2011 for the treatment of traumatic TMPs in humans that affected greater than 50% of the TM. The closure rate, closure time, hearing gain, and rate of otorrhea were compared among the direct application of FGF, FGF via Gelfoam, and conservative treatment.

RESULTS

A total of 94 patients were analyzed. The closure rates of large perforations in the direct FGF application, FGF via Gelfoam, and observation groups were 100%, 97%, and 55%, respectively. FGF-treated groups had significantly improved closure rates compared with the observation group (p < 0.05). However, the closure rate did not differ significantly between patients who received FGF only and those who received FGF via Gelfoam (p > 0.05). FGF-treated groups showed shorter mean closure times compared with the observation group (p < 0.05). However, the closure time did not differ significantly between FGF-treated groups (p > 0.05).All perforations were closed within 2 weeks, regardless of the presence of curled edges in the FGF-treated groups.

Ear trauma in orlu, Nigeria: a five-year review

To review the presentation, types and aetiology of ear trauma and various factors affecting ear trauma in our patients over a 5 year period. All patients treated for ear trauma over a 5 year period were studied using their clinical records. Data extracted were analysed using SPSS version 11 software. The results were presented in simple descriptive and tabular forms. Forty-one patients, 18(43.90%) males and 23(56.10%) females were studied, ages 12-43 years, average 26.3 + 5 years. Blows/Slaps (65.85%) from assault was the commonest aetiology while bleeding from the ear (73.17%), hearing loss (70.73%) and tympanic membrane perforation (68.29%) were the most frequent presentations. Ear trauma is common and mostly affects the tympanic membrane. Sudden increase in canal pressure from blows/slaps was the major mechanism of injury. Management outcome was good except for few late presenters with compilations.

Healing of laser-induced tympanic membrane perforations in rats: no contribution of granulocyte colony-stimulating factor or Gelfoam

OBJECTIVES

To study whether granulocyte colony-stimulating factor together with Gelfoam (absorbable gelatin sponge, USP) could enhance the healing of freshly perforated tympanic membranes. The frequency and occurrence of different immunocompetent cells and collagen types was noted.

METHODS

Laser perforations were made in the tympanic membrane of rats that were sacrificed at different time intervals post-myringotomy: Day 1, 3, 6, and 12. Tympanic membrane specimens were embedded and sections were stained with hematoxylin/eosin and an immunohistochemical technique was used, with antibodies against macrophages, B-cells, T-cells, and type I-IV collagens. Semi-quantification was performed after counting positive cells, mean values were calculated and analyzed statistically.

RESULTS

All perforations, except one, had closed by Day 12 and no difference was observed between experimental and control ears at the other time points. Gelfoam was still present in a high amount at Day 12. The sections were initially stained positive for type I and II collagen, but after Day 6, the regenerating tissue stained positive for mainly type III and IV collagens. Results showed that the recruitment of macrophages, B-cells, and T-cells could not be mapped with a statistical significance.

CONCLUSIONS

This study showed that at 6-12 days post-laser myringotomy, type III and IV collagen has replaced the collagen type II that normally constitutes the healthy tympanic membrane. There is a concern for excessive scarring involving adjacent structures. It was also seen that the combination of Gelfoam and granulocyte colony-stimulating factor or saline did not affect the healing times in perforated tympanic membranes. No significant results regarding the inflammatory cell recruitment could be obtained on the studied time points or between experimental and control ears, except for in the Gelfoam matrix.

Biocompatibility evaluation of cigarette and carbon papers used in repair of traumatic tympanic membrane perforations: experimental study

The purposes of this study were to investigate the biocompatibility of two different paper patches (carbon and cigarette papers) and compare the adhesion and proliferation features of L929 fibroblast cells by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT Test) test and scanning electron microscopy (SEM). In this study, time-dependent cytotoxic effects of cigarette and carbon papers used in repairing small traumatic TM perforations were investigated in vitro by using MTT test. And also adhesion and spreading of cells over disk surface were observed by SEM. Cytotoxicity test carried out by MTT analysis on leakage products collected from two types of paper patches at the end of 24 and 48 h revealed no cytotoxicity (P > 0.05). In SEM studies, it was observed that cells started to proliferate over disk surface as a result of 48-h incubation, and SEM revealed that the cell proliferation over cigarette paper was more compared to the one over carbon paper. We believe that this is the first study where biocompatibility and adhesion features of carbon and cigarette paper have been studied by using L929 fibroblast cell culture. As a result, biocompatibility of cigarette paper and also whether cigarette paper was superior to carbon paper in cell attachment and biocompatibility were studied. It was found, by MTT test and SEM test, that cigarette paper had a higher biocompatibility and cell attachment, and thus cigarette paper should be the patch to be preferred in cases where TM perforations are repaired by paper-patch method.

A randomised controlled trial comparing spontaneous healing, gelfoam patching and edge-approximation plus gelfoam patching in traumatic tympanic membrane perforation with inverted or everted edges

OBJECTIVE

To compare the outcome of patients with dry traumatic tympanic membrane perforation after spontaneous healing and gelfoam patching with or without perforation edge approximation.

DESIGN

Prospective clinical study.

SETTING

University-affiliated teaching hospital.

PARTICIPANTS

Ninety-one patients with acute dry traumatic tympanic membrane perforation inverted or everted edges were recruited. They were randomly allocated to three groups: spontaneous healing (n=31), gelfoam patching (n=30) and edge-approximation plus gelfoam patching (n=30). Otoscopy and tympanometry were performed before the treatment and at follow-up visits.

MAIN OUTCOME MEASURES

  Healing rate, healing time, ear infection rate and morphological changes during healing process.

RESULTS

The overall healing rate was 85% in the spontaneous healing group, lower than that in the two gelfoam patching groups (97%), but the difference failed to reach a statistical significance (P>0.05). The average healing time was 30 ± 10.1 days in the spontaneous healing group, significantly longer (P<0.01) than that in the other two groups (16 ± 5.6 and 18 ± 4.7 days, respectively). Middle ear infection rate did not differ significantly (7%, 3% and 3%, respectively). Spontaneous healing resulted in formation of scabs at the perforation edges, which was effectively prevented by gelfoam patching.

CONCLUSIONS

Gelfoam patching may facilitate healing of traumatically perforated tympanic membrane. Approximation of folded perforation edges is not necessary in gelfoam patching.

Effect of treatment at different time intervals for traumatic tympanic membrane perforation on the closure

CONCLUSION

Treatment of traumatic tympanic membrane (TM) perforation with everted or involute edge flaps at different time intervals within 1 week after the injury did not affect the perforation closure rate and mean closure time.

OBJECTIVE

To retrospectively analyze the effect of treatment at different time intervals for traumatic tympanic membrane perforation with gelatin sponge patch and edge approximation plus gelfoam patching.

METHODS

Patients with traumatic TM perforation visited at different days since the injury for medical treatment (1, 2, 3, 4, and 5-7 days post trauma). These patients were treated with the following prominent methods of treatment: gelatin sponge patch treatment and edge approximation plus gelfoam patching. Measurement indicators were perforation closure rate and mean closure time at 3 months.

RESULTS

In the group treated with the gelatin sponge patch technique, the patients sought medical treatment at different time intervals since the injury. Accordingly, the outcome of the treatment varied in terms of the perforation closure rates achieved in different patients in this group. The respective perforation closure rates were 100%, 100%, 96%, 94%, and 89% in accordance with the time interval at which the patients were treated since the injury. The results were not significantly different when compared by statistical analysis (p > 0.05); the mean closure times in each of the different sets of cases in this group were calculated and the following values were reported: 7.1 ± 2.3, 8.2 ± 1.6, 8.7 ± 1.2, 9.2 ± 3.1, and 10.7 ± 3.9 days. On the other hand, in the edge approximation plus gelfoam patching group, the perforation closure rates were 100%, 97%, 96%, 97%, and 94%, respectively. This was in accordance with the time elapsed since the injury for the patients who visited the hospital on different days. Statistical analysis confirmed that the perforation closure rates for the different cases of this group did not have any significant difference (p > 0.05); the mean closure times were 7.6 ± 1.9, 7.9 ± 2.2, 9.2 ± 2.8, 8.5 ± 3.6, and 11.2 ± 4.1 days, respectively, indicating that differences were not significant even in terms of mean closure rates for the different cases of this group (p > 0.05).

Outcome of children with edge-everted traumatic tympanic membrane perforations following spontaneous healing versus fibroblast growth factor-containing gelfoam patching with or without edge repair

OBJECTIVES

To retrospectively analyze the outcome of children with edge-everted tympanic membrane (TM) perforations following spontaneous healing and fibroblast growth factor-containing gelfoam patching with or without repair of the edge flaps.

METHODS

Medical records of children with TM perforations who underwent spontaneous healing (n = 69) or received fibroblast growth factor (FGF)-containing gelfoam patching treatment (n = 67) were retrieved from the Records Department of the Wenzhou Medical College-Affiliated Yiwu Hospital in China. The demographic data and outcome measures were analyzed and compared between these two groups of patients.

RESULTS

Patching with FGF-containing gelfoams significantly improved the healing rate (P < 0.01) and the average perforation closure time (P<0.01), as compared with spontaneous healing. Repair of the perforation edge flaps did not significantly affect the outcome of gelfoam patching (P>0.05), despite a slightly reduced healing rate (96.4% versus 100%) and a slightly shorter closure time (10.2 ± 2.6 d versus 10.9 ± 3.3 d) observed as compared with no edge repair. The everted perforation edge flaps formed scabs during the process of spontaneous healing whereas they underwent retraction and eventually dissolved during the process of gelfoam patching-facilitated healing.

CONCLUSIONS

As compared with spontaneous healing, FGF-containing gelfoam patching had an improved outcome in children with edge-everted traumatic eardrum perforation. Repair of everted edge flaps did not affect the healing outcome. Our results suggest that growth factor-containing gelfoam patching without eardrum flap repair would offer a feasible option to manage traumatic tympanic membrane perforations in children.

Repair of Large Traumatic Tympanic Membrane Perforation with a Steri-Strips Patch

Objective. To investigate the effects of the Steri-Strips patch (3M) on the treatment of large traumatic tympanic membrane perforations (TMP).

Study Design. Prospective, randomized, controlled.

Setting. Tertiary university hospital.

Subjects and Methods. A randomized prospective analysis was performed between February 2009 and January 2011 for the treatment of traumatic TMP larger than 50% of the entire tympanic membrane. The results of closure rate, closure time, hearing gain, and rate of otorrhea between conservative observation, paper patching, and Steri-Strips patching groups were compared.

Results. In total, 87 patients were analyzed in this study. The closure rates of the perforations in the Steri-Strips patching, paper patching, and observation groups were 93.3%, 84.2%, and 78.9%, respectively. There was no statistically significant difference in tympanic membrane closure rate between the 3 groups. The Steri-Strips technique decreased the need for repeat procedures. Overall, the Steri-Strips and paper patching groups showed shorter healing times compared with the observation group. However, there was an increased rate of otorrhea in the Steri-Strips group compared with the observation group.

Conclusion. Steri-Strips patching reduced the healing time and need for repeat procedures in patients with large traumatic TMPs. However, the occurrence of otorrhea was significantly more common in patients treated with the Steri-Strips technique.

Bilateral same-day surgery for bilateral perforated chronic otitis media: Inlay butterfly cartilage myringoplasty

OBJECTIVE

Conventional bilateral same-day tympanoplasty or myringoplasty has been rarely performed because of the risk of postoperative complications. Inlay butterfly cartilage myringoplasty (IBCM) has been shown effective for same-day closure of bilateral tympanic membrane perforations and is a quicker and more comfortable procedure for the patient. Immediate postoperative hearing is not compromised by packing materials because no external canal packing or middle ear support is required. We assessed the efficacy and safety of bilateral same day IBCM.

STUDY DESIGN

Case series with chart review.

SETTING

Tertiary referral center.

SUBJECTS AND METHODS

Of the 81 patients (age range, 9–64 years) who underwent conventional tympanoplasty/mastoidectomy for bilateral perforated chronic otitis media between June 2005 and September 2009, 17 with small-to-medium perforations and no history of otorrhea underwent same-day cartilage IBCM on the contralateral ear. Median follow-up duration was 13.0 months.

RESULTS

The graft take rate was 100 percent, with no retraction pockets or displaced grafts observed during follow-up. Mean air—bone gap was improved from 15.8 to 8.4 dB. Twelve patients had an average air—bone gap between 0 and 10 dB, three between 11 and 20 dB, and two between 21 and 30 dB. Two patients had myringitis postoperatively, but it improved with antibiotic treatment.

CONCLUSION

Bilateral same-day IBCM offers favorable outcomes in selected patients.

Basic fibroblast growth factor combined with atelocollagen for closing chronic tympanic membrane perforations in 87 patients

OBJECTIVE

To present the clinical results of closing chronic tympanic membrane (TM) perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane patch.

STUDY DESIGN

Closure of TM perforations in 87 patients was attempted using bFGF, which is thought to promote the regeneration of TM tissues by facilitating the growth of fibroblasts and collagen fibers.

METHODS

Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane was placed in the perforation with the silicon layer facing outward and then infiltrated with 0.1 ml of trafermin. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete TM closure.

RESULTS

The mean perforation size before treatment was 14.4%. Complete closure of the TM perforation was achieved in 80 patients (92.0%), whereas pinholes remained in 5 patients (8.7%), and small perforations were observed in 2 patients (2.3%). In the patients with complete closure, the TM perforations closed after an average 1.8 treatments, and hearing improved by 13.6 dB.

CONCLUSION

This study demonstrated that bFGF combined with atelocollagen is effective for the conservative treatment of TM perforation.

[CO2-laser-assisted de-epithelialization of perforation margins of persistent tympanic membrane perforations. An alternative to conventional surgical procedures]

INTRODUCTION

The standard treatment of persistent eardrum perforation is conventional surgical closure using myringoplasty or a tympanoplasty type I. In this study the valence of a modified, CO(2)-laser-assisted de-epithelialization of perforation margins was investigated.

MATERIAL AND METHODS

A total of 44 patients with mesotympanal eardrum perforation (diameter 1-5 mm) were included in a partially retrospective and partially prospective study. The genesis of the eardrum perforations was partially traumatic or the eardrum did not heal after spontaneous perforation caused by an acute otitis media or after surgery. The procedure was performed under topical anaesthesia. Focussed, adjacent, single CO(2) laser pulses (1 watt, 0.05 s) were applied with the laser otoscope Otoscan (Lumenis, Yokneam, Israel) along the edge of the perforation until complete de-epithelialization. This was done to stimulate growth. Closure of eardrum perforation was monitored using an ear microscope and if this treatment was not successful after three attempts conventional surgical therapy was suggested.

RESULTS

Complete eardrum closure occurred in 27 cases (61%), 17 patients (39%) had a residual perforation, of which 9 experienced a significant reduction of the perforation. There were no complications during and after the treatment.

CONCLUSION

A closure rate of at least 61% (27/44) can be expected with a CO(2)-laser-assisted de-epithelialization of the perforation margins. This procedure can be performed under topical anaesthesia and is an economic, painless and facile alternative to conventional surgical treatment.

Middle Ear Injury through the External Auditory Canal: A Review of 44 Cases

We performed a retrospective review of 44 patients with middle ear injury incurred through the external auditory canal. Twenty-two of the 44 patients had presented to our center within 1 month of their injury (early group), and 22 presented later (delayed group); the mean interval from the time of the trauma to presentation was 6 days in the early group and 7 years in the delayed group. The causes of injury were penetrating trauma (70% of cases), thermal insults (20%), and explosive and nonexplosive blasts (9%). Purulent otorrhea, cholesteatoma, and ossicular discontinuity were more common in the delayed group. Otologic surgery was required in 9 early-group patients (41%) and in all 22 delayed-group patients (100%). Two patients in the early group developed a dead ear. The mean pure-tone averages (PTAs) at presentation were 30.7 and 52.2 dB in the early and delayed groups, respectively; after management, the corresponding mean PTAs were 21.0 and 42.5 dB. The respective mean air-bone gaps in the two groups were 14.6 and 28.2 dB at presentation and 8.0 and 17.2 dB after management. We conclude that middle ear injury incurred as a result of trauma sustained through the external auditory canal is associated with considerable morbidity. Patients who present in a delayed fashion have significantly poorer hearing at presentation and after management. Patients who do not develop a dead ear generally derive benefit from reconstruction of the middle ear sound-conduction mechanism.

Reevaluation of Bilateral Same-Day Surgery for Bilateral Perforated Chronic Otitis Media

OBJECTIVE

To evaluate the results of bilateral same-day surgery for bilateral perforated chronic otitis media in comparison with our previous report.

STUDY DESIGN

Prospective study.

PATIENTS

Seventeen patients ranging in age from 5 to 70 years (mean, 52.5 yr), with bilateral perforated chronic otitis media.

METHODS

Two hundred cases of chronic otitis media were operated on at the Department of Otolaryngology, Hyogo College of Medicine from December 1998 to November 2002. Fifty-nine patients (29.5%) had bilateral disease and 17 patients (8.5%) underwent bilateral same-day surgery.

RESULTS

The postoperative air-bone gap was less than 10 dB on both sides in 5 of 17 (29%) and less than 20 dB in 15 of 17 (88%). The postoperative hearing level was less than 20 dB in both ears in 4 of 17 (24%), less than 30 dB in 7 of 17 (41%), and less than 40 dB in 10 of 17 (59%). The rate of closure of the ear drum was 20 of 22 (91%) in the simple underlay myringoplasty series and 9 of 12 (75%) in the conventional myringoplasty/tympanoplasty series. The rate of closure of the ear drum on both sides was successful in 4 of 5 (80%) that underwent simple underlay myringoplasty/simple underlay myringoplasty and 8 of 12 (67%) that underwent simple underlay myringoplasty/conventional myringoplasty/tympanoplasty, whereas that on at least one side was successful in 100%.

CONCLUSION

Bilateral same-day surgery for bilateral perforated chronic otitis media is possible if operative indications are considered. Furthermore, it will help patients save time and money.

A new method for closing tympanic membrane perforations using basic fibroblast growth factor

OBJECTIVE

To present a new method for closing tympanic membrane perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane as a patch material.

STUDY DESIGN

Closure of tympanic membrane perforations was attempted using bFGF, which is thought to facilitate the growth of fibroblasts and collagen fibers at the margin of the perforation.

METHODS

Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane infiltrated with 0.2 mL Trafermin (0.1% solution) (bFGF group) or saline (control group) was then placed in the perforation with the silicon layer facing outward. Nine patients were treated with bFGF, and five were treated with saline. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete tympanic membrane closure.

RESULTS

The mean perforation size before treatment was 16.5% in the bFGF group and 9.6% in the control group. Closure of the tympanic membrane perforation was achieved in all cases in the bFGF group, whereas it was achieved in only two of five cases in the control group. With bFGF treatment, the tympanic membrane perforations closed completely within 3.7 weeks, and hearing improved by 13.3 dB in the bFGF group.

CONCLUSION

The study demonstrated that bFGF combined with an atelocollagen/silicone bilayer membrane is effective for the conservative treatment of tympanic membrane perforation.

Topical treatment with growth factors for tympanic membrane perforations: progress towards clinical application

Basic scientific research has demonstrated that epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), platelet-derived growth factor-AA (PDGF-AA) and transforming growth factor-alpha (TGF-alpha) are induced by acute tympanic membrane (TM) perforation. The expression of these growth factors peaks during the inflammatory phase and then declines, suggesting their involvement in the healing process of the TM. Expression of EGF receptor, bFGF receptor, PDGF receptor and keratinocyte growth factor (KGF) receptor in the TM has also been reported. Identification of these receptors indicates that the target cells in the TM may be stimulated during the process of healing by the corresponding exogenous growth factor in vivo. Some reports from animal studies showed encouraging effects of EGF, bFGF and PDGF-AA in terms of accelerated or enhanced healing of acute and chronic TM perforations without significant adverse effects. Two reports of clinical trials of topical application of EGF or bFGF for TM perforations revealed mixed results. In this article special considerations for future directions of research into growth factors are discussed and related articles on healing of skin wounds and other lesions are reviewed. Further experimental and clinical studies on the mechanism of action of growth factors, timing of application, selection (either singly or in combination), delivery mode, dose and safety aspects, as well as more clinical trials, are warranted, and will pave the way for clinical application.

Effects of platelet-derived growth factor-AA on the healing process of tympanic membrane perforation

PURPOSE

Platelet-derived growth factor basic 30-kD disulfide-bonded dimer of A and B chains (PDGF-AA, PDGF AB, PDGF-BB) and a cytokine, promoting wound healing by its mitogenicity for fibroblast and by stimulating the production of fibronectin and hyaluronic acid. This article investigates the effect of PDGF on the healing process of tympanic membrane (TM) perforation.

MATERIALS AND METHODS

The pars tensa of the posterior aspect of the TM of rats was excised and treated with 2 microg of PDGF-AA or placebo. The animals were killed at 3, 5, 7, 9, 11, 15, and 28 days after operation. The healing process of TM perforation was observed with a telescope and light microscope. The temporal bones were also immunohistochemically examined for PDGF-alpha receptor (PDGF-R(alpha)) and fibronectin.

RESULTS

All PDGF-AA-treated TM were completely closed by 5 days after surgery, whereas some of the placebo-treated TM were not closed at 15 postoperative days. PDGF-AA induced the most prominent proliferation of the connective tissue by 9 postoperative days, after which the growth of the connective tissue decreased. By the 4th postoperative week, the PDGF-treated TM were slightly thicker than normal TM. An intense expression of fibronectin was detected in the connective tissue layer of the TM that were treated with PDGF-AA. PDGF-R(alpha) was expressed in the epithelial layer of both the PDGF-treated and control TM.

CONCLUSION

These results show that PDGF-AA speeds up the healing process of TM defect, improves the rate of healing, and prevents atrophic changes in the healed TM by promoting the connective tissue growth. The use of PDGF-AA can be an effective alternative to surgery for managing TM perforations.

Bilateral same day surgery for bilateral perforated chronic otitis media

OBJECTIVE

Bilateral same day surgery has been performed rarely because of the risk of postoperative sensorineural hearing loss following conventional myringoplasty or tympanoplasty (CMT). Simple underlay myringoplasty (SUM) through the ear canal has been developed by Yuasa R, Saijo S, Tomioka Y, et al. Office closure of eardrum perforation with fibrin glue (in Japanese), Otolaryngol Head Neck Surg (Tokyo) 1989;61:1117-1122, which has little risk of sensorineural hearing loss. We tried bilateral same day surgery using this technique and evaluated its outcome.

METHODS

Of 86 cases with bilateral perforated chronic otitis media that we treated between 1995-1997, 25 cases underwent bilateral same day surgery. Bilateral SUMs was performed on seven patients, SUM and CMT on 16 patients, and bilateral CMTs on two patients.

RESULTS

Closure of perforation was successful in 18 patients (72%) on both sides and in seven patients (28%) on one side. Postoperative air-bone gap of less than 20 dB was achieved in 15 cases (60%) on both sides and in 23 cases (92%) on one side.

CONCLUSION

Bilateral same day surgery for bilateral perforated chronic otitis media is possible if the operative indications are considered.

Simple in-office closure of small intractable tympanic membrane perforations after myringoplasty

Perforations produced following myringoplasty are very difficult to close by ordinary cautery or patching even if they are small. Therefore we decided to close these intractable perforations with a skin graft from the cartilaginous ear canal. Our method is an in-office operation under local anesthesia. After the removal of epithelium from around the perforation a skin graft was placed by the over-lay method. A total of 11 patients were treated, of which 81.8% (9/11) demonstrated successful closure in the initial surgery and two re-perforations were successfully closed by a second and third operation, respectively. The technique used in this surgery is relatively easy and appropriate for in-office operations. The method's advantages include decreased invasiveness with minimal anesthesia and no requirement for ear canal packing or fixatives, and cosmetic benefit. This method also can be applied to perforations caused by chronic otitis media, traumatic perforations, and perforations after inserting tubes.

Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience

Widespread controversy exists concerning the treatment of traumatic tympanic membrane perforations. To elucidate the issue, a reference value for the rate of spontaneous tympanic membrane closure in man, to which the healing rates following different techniques of early surgical repair should be compared, was established on the basis of a review of more than 500 texts covering a century's literature on the traumatically perforated tympanic membrane. The spontaneous healing rate appeared to be close to 80 (78.7 per cent) in 760 evaluable cases of traumatic tympanic membrane perforations of all sorts diagnosed within 14 days post injury. A relative, causal-related variation of spontaneous healing could be demonstrated, and a pathogenetic classification of direct traumatic tympanic membrane perforations into ruptures induced by air-pressure changes, heat or corrosives, solids, and water pressures, is of proved clinical value and may have medico-legal validity. There is an obvious need for clinically controlled studies on the spontaneous healing of all kinds of traumatic perforations of the tympanic membrane in humans, and important elements in the design of future studies are advocated.

Repair of chronic tympanic membrane perforations using epidermal growth factor

Perforation of the tympanic membrane (TM) is a frequent cause of conductive hearing loss. Persistent TM perforations often require surgical repair with an autologous tissue graft to restore hearing and prevent recurrent infection. While highly efficacious, this method of closure requires a relatively complex and expensive microsurgical procedure. We have recently developed a chronic TM perforation model in the chinchilla for use in the exploration of novel methods of TM repair.