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Kozin ED, Lee DJ, Remenschneider AK. Bilayer Graft for Incisionless In-Office Endoscopic Repair of Tympanic Membrane Perforations: A Pilot Study. OTO Open 2019; 3:2473974X19869911. [PMID: 31489397 PMCID: PMC6712757 DOI: 10.1177/2473974x19869911] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 07/25/2019] [Indexed: 12/02/2022] Open
Abstract
Tympanic membrane (TM) perforations may result in significant patient morbidity. While intraoperative myringoplasty or tympanoplasty allow for effective repair, not all patients are candidates for general anesthesia. Herein, we describe a novel graft design and technique for in-office repair of TM perforations in the clinic setting. Two pieces of porcine submucosa material were interdigitated to create a bilayer design with lateral and medial flanges. Topical and injected lidocaine were used for local anesthesia. The perforation was rimmed. Grafts were grasped, and medial flanges were placed through the perforation, with lateral flanges resting on the TM surface. TM repair occurred in 5 awake patients with a mean age of 72 years. There were no complications. All perforations healed, with 1 case requiring a minor in-office revision. Audiometry was performed at 4 weeks. The preoperative air-bone gap (mean 0.25, 0.5, 1, 2, and 4 kHz) was 12.2 ± 4.1 dB, and postoperatively, it was 4.2 ± 2.4 dB (P = .001). Novel design of available graft material may allow for effective in-office TM repair.
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Affiliation(s)
- Elliott D Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Daniel J Lee
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Aaron K Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA.,Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.,Department of Otolaryngology, UMass Memorial Medical Center, Worcester, Massachusetts, USA
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Kozin ED, Black NL, Cheng JT, Cotler MJ, McKenna MJ, Lee DJ, Lewis JA, Rosowski JJ, Remenschneider AK. Design, fabrication, and in vitro testing of novel three-dimensionally printed tympanic membrane grafts. Hear Res 2016; 340:191-203. [PMID: 26994661 DOI: 10.1016/j.heares.2016.03.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/07/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022]
Abstract
The tympanic membrane (TM) is an exquisite structure that captures and transmits sound from the environment to the ossicular chain of the middle ear. The creation of TM grafts by multi-material three-dimensional (3D) printing may overcome limitations of current graft materials, e.g. temporalis muscle fascia, used for surgical reconstruction of the TM. TM graft scaffolds with either 8 or 16 circumferential and radial filament arrangements were fabricated by 3D printing of polydimethylsiloxane (PDMS), flex-polyactic acid (PLA) and polycaprolactone (PCL) materials followed by uniform infilling with a fibrin-collagen composite hydrogel. Digital opto-electronic holography (DOEH) and laser Doppler vibrometry (LDV) were used to measure acoustic properties including surface motions and velocity of TM grafts in response to sound. Mechanical properties were determined using dynamic mechanical analysis (DMA). Results were compared to fresh cadaveric human TMs and cadaveric temporalis fascia. Similar to the human TM, TM grafts exhibit simple surface motion patterns at lower frequencies (400 Hz), with a limited number of displacement maxima. At higher frequencies (>1000 Hz), their displacement patterns are highly organized with multiple areas of maximal displacement separated by regions of minimal displacement. By contrast, temporalis fascia exhibited asymmetric and less regular holographic patterns. Velocity across frequency sweeps (0.2-10 kHz) measured by LDV demonstrated consistent results for 3D printed grafts, while velocity for human fascia varied greatly between specimens. TM composite grafts of different scaffold print materials and varied filament count (8 or 16) displayed minimal, but measurable differences in DOEH and LDV at tested frequencies. TM graft mechanical load increased with higher filament count and is resilient over time, which differs from temporalis fascia, which loses over 70% of its load bearing properties during mechanical testing. This study demonstrates the design, fabrication and preliminary in vitro acoustic and mechanical evaluation of 3D printed TM grafts. Data illustrate the feasibility of creating TM grafts with acoustic properties that reflect sound induced motion patterns of the human TM; furthermore, 3D printed grafts have mechanical properties that demonstrate increased resistance to deformation compared to temporalis fascia.
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Affiliation(s)
- Elliott D Kozin
- Department Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Nicole L Black
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA
| | - Jeffrey T Cheng
- Department Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Max J Cotler
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA
| | - Michael J McKenna
- Department Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Daniel J Lee
- Department Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Jennifer A Lewis
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, USA; Wyss Institute for Biologically Inspired Engineering, Harvard University, Cambridge, MA, USA
| | - John J Rosowski
- Department Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA
| | - Aaron K Remenschneider
- Department Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Eaton Peabody Laboratories, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
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Kim J, Kim SW, Choi SJ, Lim KT, Lee JB, Seonwoo H, Choung PH, Park K, Cho CS, Choung YH, Chung JH. A Healing Method of Tympanic Membrane Perforations Using Three-Dimensional Porous Chitosan Scaffolds. Tissue Eng Part A 2011; 17:2763-72. [DOI: 10.1089/ten.tea.2010.0533] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jangho Kim
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
- Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
| | - Seung Won Kim
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seong Jun Choi
- Department of Otolaryngology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Ki Taek Lim
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Jong Bin Lee
- Department of Otolaryngology, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Hoon Seonwoo
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
| | - Pill-Hoon Choung
- Tooth Bioengineering National Research Lab, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Keehyun Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Chong-Su Cho
- Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jong Hoon Chung
- Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
- Research Institute for Agriculture and Life Sciences, Seoul National University, Seoul, Republic of Korea
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Oliveira JAAD, Hyppolito MA, Coutinho Netto J, Mrué F. Miringoplastia com a utilização de um novo material biossintético. ACTA ACUST UNITED AC 2003. [DOI: 10.1590/s0034-72992003000500010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A miringoplastia é uma cirurgia com a finalidade de controlar a infecção no ouvido médio, reconstruir o mecanismo de transmissão sonora para a janela oval e proteger a janela redonda. São descritos diversos materiais para reconstruir a membrana timpânica, destacando-se a fáscia do músculo temporal, pericôndrio do tragus, cartilagem, dura-máter, tecido placentário, entre outros. OBJETIVO: Este trabalho tem objetivo de demonstrar o efeito de um novo biomaterial, a membrana de látex natural com polilisina, desenvolvida no laboratório de Neuroquímica do Departamento de Bioquímica da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo - USP. FORMA DE ESTUDO: Coorte Longitudinal. MATERIAL E MÉTODO: O biomaterial utilizado é estimulante da neovascularização e crescimento tecidual organizado em diferentes órgãos e tecidos, sendo um material inócuo e não rejeitado pelo organismo. Foi usada a biomembrana de látex com polilisina como um implante transitório para o fechamento da perfuração da membrana timpânica. A membrana foi colocada na face externa dos bordos da membrana timpânica e a fáscia temporal na face interna da mesma. Foram estudadas 238 orelhas com perfuração de membrana timpânica por seqüela de otite média crônica, submetidas a miringoplastia com enxerto de fáscia de músculo temporal e a membrana de látex natural, com idades de 7 a 76 anos. Apresentavam uma ou mais miringoplastias anteriores sem sucesso 41 dos casos. RESULTADO: Como ressaltamos preliminarmente, verificamos pega do enxerto em 90,5% das orelhas (181), sendo fechamento de perfuração amplas, 96; médias, 73 e 12 pequenas. Verificamos intensa vascularização em 100% dos enxertos, o que não é habitual quando não se usa a membrana de látex natural. CONCLUSÃO: Conclue-se que o biomaterial usado merece nossa atenção quanto ao seu uso como implante transitório em miringoplastias, melhorando o processo de revascularização da membrana timpânica remanescente.
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Ma Y, Zhao H, Zhou X. Topical treatment with growth factors for tympanic membrane perforations: progress towards clinical application. Acta Otolaryngol 2002; 122:586-99. [PMID: 12403120 DOI: 10.1080/000164802320396259] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
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.
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Affiliation(s)
- Yuanxui Ma
- Tianjin Institute of Otorhinolaryngology, First Central Hospital, Tianjin Medical University, Tianjin, People's Republic of China
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Amoils CP, Jackler RK, Milczuk H, Kelly KE, Cao K. An animal model of chronic tympanic membrane perforation. Otolaryngol Head Neck Surg 1992; 106:47-55. [PMID: 1734366 DOI: 10.1177/019459989210600127] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Previous investigations into the healing and reconstruction of tympanic membrane (TM) perforations have involved animal models with acute TM perforations. A problem with the acute TM perforation model is that most acute TM perforations will heal spontaneously, both in animals and human beings. A second inadequacy of acute perforation models is that they are not analogous to the salient problem in human beings: long-standing TM perforation. The ideal animal model must have a TM perforation that is permanent, well-epithelialized, and free from infection. The perforation must also be subtotal to preserve a rim of membrane for experimental manipulations. In the chinchilla, we have identified a hardy animal with a short, wide ear canal and relatively large tympanic membranes. Thermal myringectomy, followed by medial infolding of TM microflaps, has resulted in permanent, subtotal chronic TM perforations in the chinchilla animal model. Of the 19 chinchillas (38 TMs) perforated, chronic subtotal perforations were created in 32 ears, 6 to 8 weeks after the initial procedure (84% success). Persistent infection or TM regeneration despite reperforation was recorded in 6 ears (16%) failure). This model is currently being used to assess various biomembrane scaffolds impregnated with growth-promoting substances in the regeneration of a physiologically sound TM, initially in our animal model and then in human beings. We envision the development of a biomembrane disc impregnated with biorecombinant growth factors that may provide a simple office technique for the repair of chronic, non-infected TM perforations.
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Affiliation(s)
- C P Amoils
- Coleman & Epstein Neurotological Laboratories, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco
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Fina M, Bresnick S, Baird A, Ryan A. Improved healing of tympanic membrane perforations with basic fibroblast growth factor. Growth Factors 1991; 5:265-72. [PMID: 1777236 DOI: 10.3109/08977199109000290] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We have investigated the effects of basic fibroblast growth factor (FGF) on the healing of tympanic membrane (TM) perforations. In the first series of experiments, a simple, round 1-mm perforation was made in the membrane and the effects of basic FGF examined. In a second series of experiments, basic FGF was tested on 2-mm perforations in which the borders were folded inward in order to delay normal healing. Topical applications of saline or basic FGF were administered onto gelfoam overlays of the TM perforations in 51 guinea pigs by delivering 5 microliters aliquots of PBS or 5 microliters of PBS containing 1 microgram of basic FGF on the day of surgery and daily thereafter. Repair of the lesions was evaluated 3, 5 or 8 days after surgery. The results show that basic FGF mediates faster healing of TM perforations by inducing rapid proliferation of the subepithelial connective tissue layer.
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Affiliation(s)
- M Fina
- Department of Surgery/Otolaryngology, UCSD School of Medicine, La Jolla
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