Developing Approaches to Optimise Reparative Histogenesis of the Tympanic Membrane Tissues: History, the State-of-Art and Perspectives of Reparative Otosurgery

Abstract

The paper describes the issues to optimize reparative histogenesis of the tympanic membrane tissues (history, state-of-the art and perspectives) based on data from national and foreign scientific literature. One of the causes of hearing loss is the violated integrity of the tympanic membrane, resulting from its injury or the developing inflammatory processes in the middle ear. It has been established that small perforations of the tympanic membrane can spontaneously close in the reparative stage of acute purulent otitis media or when the exacerbation of chronic purulent otitis media subsides. Restoration of large perforations of the tympanic cavity requires surgical intervention. Since 17th century, plastic surgery options for the tympanic membrane perforations with various biological and non-biological materials have been developing. However, until the beginning of the XX century, the approaches used did not lead to complete histio- and organotypic restoration of the tympanic membrane, but only ensured closure of the defect. At the present stage, otosurgeons use various plastic materials to restore the integrity of the eardrum: autografts; allografts; implants made of non-biological material. Nylon mesh, cotton-adhesive discs, and knotless knitted fabric made of polyamide fiber are applied as implants. Biological transplants applied include the skin of the inner surface of the shoulder and the occipital-temporal region, the wall of the vein, the fascia of the temporal muscle, the dura mater, the perichondrium, nanostructured bioplastic material created on the basis of hyaluronic acid hydrocolloid and a peptide complex, etc. The use of these modern options in most cases leads to organotypic and, in some cases, histiotypic restoration of the eardrum structure, ensuring complete epithelialization of its outer and inner surfaces. However, there are a number of unresolved issues regarding the diverse materials application for plastic surgery, as well as the timing of reconstructive surgeries on the middle ear.