Chronic Tympanic Membrane Perforation Research Articles

Graft Healing Process Following Cartilage Myringoplasty Without Trimming of the Perforation Margin.

Objective: The objective of this study was to endoscopically evaluate the graft healing process and graft success rate following cartilage myringoplasty, without trimming of the perforation margin or external ear canal (EAC) packing. Material and Methods: Patients with chronic tympanic membrane (TM) perforation underwent endoscope cartilage underlay myringoplasty, without trimming perforation margin or EAC packing. The healing process of the cartilage graft and the graft success rate were evaluated at 6 months postoperatively. Results: Fifty-eight ears were included in this study. At 1 week postoperatively, clinical inosculation and neovascularization of the graft were observed in small- and medium-sized perforations, but not in large or subtotal perforations. At 2 weeks postoperatively, graft clinical inosculation and neovascularization were completed in the small- and medium-sized perforations; however, neovascularization of the graft had only just begun in the large perforations. At 3 weeks postoperatively, completion of the graft clinical inosculation was achieved in 57 of the 58 ears. At 4 weeks postoperatively, complete neovascularization was achieved in all perforations. Of the 58 ears, postoperative infection resulted in residual perforation in 1 ear, and an insufficient graft resulted in residual perforation in a large perforation without infection. Overall, the graft success rate was 96.6% (56/58). There was no correlation between the graft success rate and graft neovascularization score. Conclusions: The graft healing process experienced the dilation of the blood vessels of the remnant TM, graft clinical inosculation, and neovascularization following cartilage myringoplasty without trimming of the perforation margin and EAC packing; however, the graft success rate was not related to the endoscopic graft neovascularization scores.

In Vitro Assessment of Wound-Healing Efficacy of Stabilized Basic Fibroblast Growth Factor (FGF-2) Solutions.

Chronic tympanic membrane perforations (TMP) pose a significant clinical challenge, but basic fibroblast growth factor (FGF-2) shows promise for their treatment, despite its instability in aqueous solutions which hampers the sustained delivery crucial for the healing process. Addressing this, our research focused on the development of stabilized FGF-2 formulations, F5 and F6, incorporating dual, generally regarded as safe (GRAS) excipients to enhance stability and therapeutic efficacy. F5 combined FGF-2 (1600 ng/mL) with 0.05% w/v methylcellulose (MC) and 20 mM alanine, while F6 used FGF-2 with 0.05% w/v MC and 1 mg/mL human serum albumin (HSA). Our findings demonstrate that these novel formulations not only significantly improve the cytoproliferation of human dermal fibroblasts but also exhibit the most potent chemoattractant effects, leading to the highest fibroblast monolayer closure rates (92.5% for F5 and 94.1% for F6 within 24 h) compared to other FGF-2 solutions tested. The comparable performance of F5 and F6 underscores their potential as innovative, less invasive, and cost-effective options for developing otic medicinal products aimed at the effective treatment of chronic TMP.

Controlled Release of Mesenchymal Stem Cell-Conditioned Media from a Microsphere/Gel-Based Drug Delivery System for Wound Healing of Tympanic Membrane Perforations

Chronic tympanic membrane (TM) perforation increases patient susceptibility to infection, hearing loss, and other side effects. Current clinical treatment, surgical grafting, can result in detrimental side effects including nerve damage, dizziness, or hearing loss. Therefore, it is essential to develop novel therapeutic procedures that can induce or accelerate healing in minimally or noninvasive approaches. Cell-free therapies have safety advantages over stem cells and are logistically favorable for clinical use. The regenerative potential by mesenchymal stem cell-conditioned media (CM) has been promising. In this study, poly(lactic-co-glycolic acid) (PLGA) microspheres with CM encapsulated have been developed as a cell-free alternative regenerative treatment for TM perforation. The results suggest that the PLGA microspheres were capable of encapsulating and releasing CM for up to 21 days. The in vitro scratch wound proliferation assays showed increased wound healing ability of CM-loaded microspheres. In vivo guinea pig models treated with CM drops and CM-loaded microspheres using a thermoresponsive gel carrier demonstrated potential for wound healing in TM perforation. These studies provide a basis for further examination of the delivery of stem cell CM and investigation of time-dependent wound healing, long-term ototoxicity, and hearing restoration.

Chronic tympanic membrane perforation repair with a collagen-based scaffold: An in vivo model

ObjectiveThe aim of this study was to assess the in vivo efficacy of a novel regenerative collagen-based scaffold developed by the Royal College of Surgeons in Ireland in a chronic tympanic membrane perforation (TMP) using a chinchilla model. MethodsBilateral TMPs were induced in 17 mixed gender chinchillas using tympanic membrane resection followed by a mixture of topical Mitomycin C and dexamethasone for 3 days. These were monitored with weekly otoscopy for 8 weeks. Animals were excluded if signs of infection developed in the follow up period (n = 8). At 8 weeks, intervention began and 18 TMPs were assigned to either treatment with the collagen-based scaffold (treated group) or spontaneous healing (control group). Animals were euthanized 6 weeks post-intervention. Otoscopic imaging and auditory brain response (ABR) were conducted at baseline, 8 weeks post-TMP induction and 6 weeks post-intervention. All TMPs were then evaluated at 6 weeks post-intervention and bullae underwent histologic evaluation. ResultsAt 6 weeks post-intervention, otoscopic imaging demonstrated various degrees of healing in the treated ears. The treated group was noted to have an increased rate of healing when compared to the control group. Histologic evaluation demonstrated a variation in the degree of perforation healing within groups, with some animals in the treated group showing high levels of perforation healing. At 8 weeks after the TMP procedure, most of the animals had worsened hearing response. At 6-week post the collagen-based scaffold treatment, about 50 % (4/8) of the treated ears had improved in hearing response as compared to those of non-treated ears. ConclusionGiven the initial histologic evidence of partial healing in scaffold-treated ears, the post-intervention period should be extended to monitor the potential for complete healing. Given the overall positive findings related to healing with the scaffold-treated ears, this material warrants further investigation.

Prevalence of Positive Skin Prick Test in Thai Adults with Chronic Tympanic Membrane Perforation

Objective: To find the frequency of a positive skin prick test (SPT) in patients that experienced chronic tympanic membrane perforation (TMP). Materials and Methods: Thai patients aged 18 years or older who experienced chronic TMP and presented at the Otorhinolaryngology Outpatient Unit, Siriraj Hospital, were recruited and underwent a SPT covering 18 kinds of indoor and outdoor allergens. Patients with active middle ear disease or conditions that made them unsuitable for the SPT and pregnant patients were excluded. Results: Forty-five participants were enrolled in the present study. The frequency of a positive SPT was 33.3%. Among the positive SPT group, 80% had polysensitization. Dermatophagoides pteronyssinus (mite Dp) was the most frequent positive allergen at 66.7%. The most common cause of chronic TMP in the present study was trauma. The patients’ demographic profiles in the positive and negative SPT groups showed no statistically significant differences. Conclusion: The frequency of allergy in the chronic TMP population in the present study was close to that of the normal population. Overall, the present study population had positive sensitization only to indoor allergens. Keywords: Tympanic membrane perforation; Allergy; Skin prick test

Antibacterial aligned nanofibrous chitosan/PVA patch for repairing chronic tympanic membrane perforations

Chronic tympanic membrane (TM) perforation is a consequence of trauma or chronic otitis media, and these chronic TM perforations often lead to conduction hearing loss. This study focuses on the development of a patch using a combination of chitosan (CS) and polyvinyl alcohol (PVA) as graft material for repairing chronic tympanic membrane (TM) perforations. Aligned nanofibers were created using a specially designed collector (SDC) through the electrospinning method. The scanning electron microscopy (SEM) analysis revealed that the CS/PVA ratio of (15:85) resulted in uniform and bead-free nanofibers. The aligned nanofibers had a diameter of 131.11 ± 28 nm, indicating that the influence of the electrostatic field introduced by the SDC affected not only the nanofiber alignment but also the nanofiber diameter. The nanofiber angles demonstrated effective alignment. This patch is infused with thyme essential oil (TEO) for antibacterial properties. The results showed that its antibacterial property for Pseudomonas aeruginosa bacteria was enhanced in such a way that the diameter of the antibacterial halo increased from zero to 25 mm. Cell viability assays showed >80 % viability. A preclinical case study on six patients demonstrated the biocompatibility and promising potential of the fabricated patch for eardrum repair.

Effect of Packing Versus No Packing in Transperforation Myringoplasty for Chronic Tympanic Membrane Perforations.

To compare the operation times, graft survival and success rates, audiometric outcomes, and complications of patients who underwent transperforation myringoplasty with and without packing but without perforation rimming. A prospective, randomized controlled trial. A university-affiliated teaching hospital. We conducted a randomized controlled trial that enrolled patients who underwent underlay myringoplasty. No patient underwent perforation rimming. Patients underwent myringoplasty with or without graft lateral packing. The operation times, graft survival and success rates, audiometric outcomes, and complications were compared between the 2groups. Sixty patients with unilateral perforations were included. The mean neovascularization score at postoperative week 2 was significantly higher in the no-packing group than in the packing group (p < .01) but did not differ significantly at postoperative weeks 3 and 4, or postoperative month 3. Neither the graft healing rate (p = .313) nor the perforation closure rate (p = .640) significantly differed between the 2groups. The mean air-bone gap improved by 8.91 ± 5.45 dB in the packing group and 8.17 ± 1.19 dB in the no-packing group (p = .758). The long-term graft success and hearing improvements in transperforation myringoplasty with no rimming of the perforation and no-graft lateral packing were comparable to those in the graft lateral packing group with no rimming of the perforation, with a low incidence of complications. These results may change the traditional practice of packing the external auditory canal and rimming the perforation in underlay myringoplasty, even for all myringoplasty surgery.

Trichloroacetic acid Alloderm™ Myringoplasty as a novel option for tympanic membrane reconstruction in children

PurposeA novel “Modified TCA Alloderm™ Myringoplasty” (TCA myringoplasty) technique for reconstruction of uncomplicated chronic tympanic membrane (TM) perforations is described. Materials and methodsDescriptive surgical technique for TCA myringoplasty on 12 total patients from 1/1/2020 to 12/31/2020. 3 patients were excluded for incomplete records. Statistical analysis employed Wilcoxon signed-rank tests. Both structural (pre/post visual inspection and tympanogram) and functional (pre/post pure tone average, PTA) outcome measures are reported. Results12 total ears were analyzed from 9 patients. Average age at surgery was 6 (range 3–22). Perforation size ranged from 10 to 60 %. Rate of structural success was 100 %. Functionally, postoperative PTA were significantly decreased from preoperative (mdn(range) = 18.44(13.13–24.38) vs mdn(range) = 11.25(6.25–22.50), p = .008). Only one TM required >1 procedure to achieve closure. ConclusionsChronic TM perforations are typically reconstructed via Type I tympanoplasties with temporalis fascia, reserving myringoplasty for favorable perforations (<25 % in size and posterior). Our novel TCA myringoplasty technique has excellent outcomes independent of size and location. We apply a chemical peel concept to a modified myringoplasty technique, obviating incisions and graft harvest. Advantages of Alloderm™ include: 1) a more rigid graft, facilitating manipulation and precise placement; 2) various size and thickness options, especially useful for dimeric tympanic membranes, tympanolysis of adhesions, and bilateral perforations; 3) no donor morbidity and harvest time; 4) autologous tissue preservation. The sole disadvantage of cost is mitigated by reduced operative time and complication management. This study revealed encouraging proof-of-concept preliminary data warranting prospective and sufficiently powered analysis, supporting the technique as a viable alternative to the gold standard.

The Effect of Leptin on Chronic Tympanic Membrane Perforation: Experimental Rat Study

The Effect of Leptin on Chronic Tympanic Membrane Perforation: Experimental Rat Study

Case study of a hydrostatic pressure-induced traumatic chronic tympanic membrane perforation with purulent otorrhea and spontaneous closure

&lt;p&gt;Tympanic membrane (TM) perforations are ruptures of the membrane separating the middle and outer ear which heal spontaneously in 78.7-94% of cases. However, with large perforations and infection, the spontaneous closure rate diminishes.Chronic TM perforations are thought to rarely close spontaneously and are often treated with a myringoplasty which has a variable success rate, potential risks, and a significant recovery period during which patient activity is notably limited. Significant controversy exists over the indication for surgical intervention in the case of grade 3, chronic TM perforation with a history of infection. The aim of this case study is to provide insight into the typical progression and potential spontaneous resolution of such cases. Moreover, there is a lack of publicly available reference images outlining the progress of TM perforation healing, so detailed time-stamped photos are included. The investigators imaged, at regular intervals, a 23-year-old male’s mid-anterior chronic grade 3 TM perforation who presented with an outer and middle ear infection with purulent otorrhea. The result indicates that chronic grade 3 TM perforations with a history of infection still have potential to spontaneously close. Given the risks and inconvenience of a myringoplasty, further consideration should be taken before recommending this procedure in these cases.&lt;/p&gt;

Clinical Implementation of Platelet- and Extracellular Vesicle-Rich Product Preparation Protocols.

Extracellular vesicles (EVs) are considered essential mediators of regenerative roles of autologous platelet- and extracellular vesicle-rich plasma (PVRP) and platelet- and extracellular vesicle-rich gel (PVRG). PVRP and PVRG are novel blood-derived products gaining attraction in regenerative medicine. However, despite their reported good efficacy, their preparation protocols are too time-consuming. Moreover, patient-tailored preparation protocols are desired to optimize platelet and EV count in PVRP and PVRG. This article presents the clinical implementation of one-step, patient-tailored erythrocyte sedimentation rate (ESR)-based, PVRP and PVRG preparation protocols through the presentation of three cases: (1) large chronic tympanic membrane (TM) perforation, (2) osteoradionecrosis of the lateral skull base, and (3) cerebrospinal fluid (CSF) leak in the sphenoid sinus. These were treated with PVRP and PVRG, prepared according to our preclinically constructed mathematical sedimentation model of cells and EVs based on the patient's ESR. (1) TM healed completely after the treatment with 3.6 mL of PVRP and PVRG (high platelet and EV protocol). The speech discrimination score and air conduction pure tone average improved from 75% to 95% and from 65 to 25 dB, respectively. (2) The osteoradionecrotic surface area decreased from 46 to 18 cm2, and infection was eradicated after six applications of 13-65 mL of PVRG ("half-volume" protocol). (3) No CSF leak recurrence was detected after surgical closure with 30 mL of PVRG postoperatively. Reproducible preparation protocols proved effective, safe, fast, and straightforward enough for the surgical staff to prepare PVRP and PVRG intraoperatively. To alleviate preparation, a calculator is provided. This pilot study presents a sound basis for further studies, which are needed to assess the therapeutic effect of PVRP and PVRG. Impact statement We introduce a clinical implementation of a patient-tailored, erythrocyte sedimentation rate-based platelet- and extracellular vesicle-rich plasma (PVRP) and gel (PVRG) preparation protocol based on a mathematical model. Products proved beneficial in wound healing and were, to our knowledge, used for the first time in the treatment of osteoradionecrosis of the lateral skull base. Furthermore, this reproducible preparation protocol is fast and straightforward to implement in clinical practice. A calculator is provided to alleviate PVRP and PVRG preparation for various clinical scenarios.

To Study the Outcome of Paper Patch Myringoplasty in Patients with Tympanic Membrane Perforations

Background: The aims of our study were to evaluate the outcome of paper patch grafting in tympanic membrane (TM)&#x0D; Methods: This is a retrospective study of 50 patients that underwent paper patch myringoplasty in an outpatient setting.&#x0D; Results: The long-term success rate of paper patch grafting for TM perforation was 78.00% in this study&#x0D; Conclusion: Paper patch grafting can also be considered before formal surgical myringoplasty in the case of small, dry, chronic TM perforations.&#x0D; Keywords: Myringoplasty, TM, Paper patching.

Special Considerations for Tympanoplasty Type I in the Oncological Pediatric Population: A Case-Control Study.

IntroductionAlthough cutting-edges antineoplastic therapies increase survival in children with malignancies, the optimal surgical strategy to address associated comorbidities such as chronic tympanic membrane perforation is still poorly documented. The aim of this study is to evaluate the outcomes of type I tympanoplasty in pediatric cancer survivors who received chemo and/or radiotherapy to the skull and to identify potential associated risk factors.MethodsThis case-control study included medical records review of oncologic patients (age <21) treated at the same Academic medical oncologic center between March 2015 and July 2021 and referred for conductive hearing loss and chronic tympanic membrane perforation. Patients and middle ear status-related variables were analyzed, and outcomes were compared with matched peers without any history of malignancies.ResultsA total of seven pediatric cancer survivors and seven paired children without any history of malignancies were included in this report. The mean age at tympanoplasty type I surgery was 10.2 years (range = 4.3–19.9; median = 7.9 years) for the pediatric cancer survivors' group and 10.1 years (range = 5.5–19.2; median = 7.9 years) in the control group. Three pediatric cancer patients had received chemotherapy alone, one patient had radiotherapy to the skull base, and three patients had received chemoradiotherapy. On average, surgery was performed 3.9 years after chemo and/or radiotherapy termination, except for 1 patient for whom the tympanoplasty was performed during chemotherapy treatment. A retroauricular approach was used for one of the pediatric cancer patients, a transcanal approach was performed in one other and five patients benefited from an otoendoscopic approach. Tragal perichondrium with cartilage was used in most of the pediatric cancer survivor cases (four out seven cases) while xenograft (Biodesign) and Temporalis fascia without cartilage graft were used in five out of the seven control cases. Rate of tympanic membrane perforation recurrence was similar between groups (28.6%). Mean functional gain for air conduction Pure Tone Average (AC PTA) was 2.6 and 7.7 dB HL for the oncologic and control group, respectively. Mean postoperative air-bone gap (ABG) was 10.7 dB HL [median = 8.7; inter-quartile range (IQR) = 13.8] for the oncologic cohort and 10.1 dB HL (median = 10.7; IQR = 9.6) for the control group.DiscussionChemo- and chemoradiotherapy to the skull are associated with damages to the inner and middle ear structures with secondary eustachian tube dysfunction and chronic middle ear effusion. Although healing abilities and immunological defenses are compromised as part of the expected effects of antineoplastic therapies, type I tympanoplasty can be safe and effective in this population. While different approaches may be considered, otoendoscopy showed excellent results with less morbidity in this vulnerable population.

Mesenchymal Stem Cells for Treatment of Delayed-Healing Tympanic Membrane Perforations Using Hyaluronate-based Laminas as a Delivery System: An Animal Model With Histopathologic Study.

Bone marrow derived-mesenchymal stem cells (BM-MSCs) improve the healing of chronic tympanic membrane perforations (cTMPs) in an animal model. cTMPs generate significant morbidity and reduced quality of life, usually requiring surgical assistance. With growing interest in alternative therapies, we sought to evaluate the effect of BM-MSC-therapy on the healing of cTMPs. Sixty cTMPs were established in C57Bl/6 mice and randomized into four groups: hyaluronate scaffold as graft plus BM-MSCs (n = 19 ears), scaffold plus cell culture media (n = 16), scaffold plus phosphate-buffered saline (PBS, n = 12), and no intervention (n = 13). Hyaluronate scaffolds with or without BM-MSCs were applied on 8-week perforated eardrums. After a blinded assessment of perforation sizes at baseline and 2 weeks after treatment, mean perforation reduction rates (%) were compared. Histology characterization was then performed. Mean perforation size reduction rates were significantly higher for cTMPs that received scaffolds plus BM-MSCs (Student's t test, p = 0.0207, 12.3% [95% CI: 7.8-16.7]) and scaffolds plus cell culture media (p = 0.0477, 11.3% [95% CI: 4.4-18.2]) when compared with no intervention (4.2% [95% CI: 1.2-7.2]). This was not observed when treating eardrums with scaffolds plus PBS (7.3% [95% CI: 2.7-11.9]). On histology, BM-MSC-treated eardrums demonstrated restoration of the trilaminar configuration and reduced inflammatory changes, while other groups developed tissue architecture disorganization and hypercellular infiltrates surrounding the perforation site. BM-MSCs and cell culture media equivalently increased cTMP healing rates. Cell-based therapy conferred a restoration of the trilaminar configuration of the eardrum with relatively compact and organized fibrous layers.

Comparison ofendoscopic over-underlay technique with and without packing forrepairing chronic perforation.

This study was performed to compare the efficacy of the endoscopic modified cartilage over-underlay technique with and without packing for repairing chronic tympanic membrane (TM) perforations. A total of 70 cases of chronic TM perforation were randomly allocated to endoscopic modified cartilage over-underlay myringoplasty groups with (n = 35) and without (n = 35) packing. The graft success rate and hearing outcomes were compared between the two groups. In addition, neovascularization scores were subjectively obtained. At 12months postoperatively, the difference in graft success rate between the packing and no-packing groups was not significant (94.3% vs. 100.0%, P = 0.473). In addition, there were no significant differences between the two groups in the pre- or postoperative air-bone gap (ABG) (15.18 ± 2.73 vs. 15.07 ± 4.02, P = 0.623 and 8.63 ± 3.03 vs. 8.52 ± 4.50, P = 0.591) or mean ABG gain (6.56 ± 3.23 vs. 6.54 ± 2.83, P = 0.751). However, the average operating times were 43.6 ± 7.1 and 32.7 ± 2.1min in the packing and no-packing groups, respectively (P < 0.001). Surgical and hearing outcomes were comparable between patients with chronic TM perforation treated using the endoscopic modified over-underlay technique with and without packing. However, without packing, the procedure was less invasive and had a shorter operating time.

Middle Ear Packing and External Ear Packing With Fibrin Glue Enhance the Success of Fat Myringoplasty Without Hyaluronic Acid Disc.

Recently, hyaluronic acid disc has been known to enhance the success rate of fat myringoplasty. However, hyaluronic acid disc (Epidisc) is not covered by south Korean medical insurance. To date, fat myringoplasty using middle ear packing has rarely been reported. In this study, we studied whether middle ear packing with dexamethasone soaked gelfoam and fibrin glue over the fat graft could promote the success rate of tympanic membrane perforation (TMP) closure without hyaluronic acid disc, regardless of perforation size. Between January 2005 and July 2020, a total of 209 patients who underwent fat myringoplasty due to chronic TMP at a tertiary referral center were enrolled, and the success rate and audiologic outcomes were analyzed. The mean successful tympanic membrane (TM) closure rate was 88.0%. The success rate by different age groups showed no significant difference. Further, the size of perforation showed no significant difference, and the perforation site (anterior or posterior) was not significant. The preoperative mean thresholds of air conduction (AC), bone conduction (BC), and air-bone gap (ABG) were 55.71, 12.98, and 42.73 dB respectively. The postoperative mean thresholds of AC, BC, and ABG were 23.67, 12.98, and 10.69 dB, respectively. Change in preoperative and postoperative hearing showed was statistically significant. Middle ear packing by gelfoam combined with external ear canal packing using fibrin glue enabled stable adhesion between the remnant TM and the fat graft. Regardless of the size of the TMP, the success rate of the fat myringoplasty by our technique can be enhanced without use of hyaluronic acid disc.

Chronic tympanic membrane perforation: Histopathological evidence of the experimental model

ObjectivesThis study aims to compare the effectiveness of three different models of chronic tympanic membrane perforations. MaterialsThe experimental study included 18 male chinchillas, divided into 3 equal groups. Group 1 perforations were performed with infolding technique myringotomy. Laser myringotomy was performed for perforation creation in Group 2. Group 3 perforations were performed with infolding myringotomy combined with ventilation tube insertion. At the end of the follow-up period, which lasts 8 weeks, all tympanic membranes with patent perforations were examined histologically. ResultsAlthough, the mean perforation patency in Group 2 was significantly higher than in Group 1 (5 vs. 2.4 weeks, p < 0.01), both of them failed in creation of chronic perforation according to time parameters. Group 3 demonstrated the longest mean perforation patency among investigated models (8 weeks). In Group 3, histological examination of perforations, which were considered to be chronic, revealed, that stratified squamous epithelium continued from the lateral surface around the perforation edge to join with the medial mucosal layer of TM. ConclusionOur findings demonstrated that the combination of infolding technique and ventilation tube insertion seems to be a potential candidate for an effective animal model of tympanic membrane perforation. Further large-scale studies are required to verify our promising results.

TO STUDY THE OUTCOME OF PAPER PATCH MYRINGOPLASTY IN PATIENTS WITH TYMPANIC MEMBRANE PERFORATIONS

Background: The aims of our study were to evaluate the outcome of office-based paper patch grafting in tympanic membrane (TM)&#x0D; Methods: This is a retrospective study of 50 patients that underwent paper patch myringoplasty in an outpatient setting.&#x0D; Results: The long-term success rate of paper patch grafting for TM perforation was 78.00% in this study&#x0D; Conclusion: Paper patch grafting can also be considered before formal surgical myringoplasty in the case of small, dry, chronic TM perforations.&#x0D; Keywords: Myringoplasty, TM, Paper patching.

Surgical outcomes of myringoplasty using platelet-rich plasma and evaluation of the outcome-associated factors

Abstract Objective Tympanic membrane perforations must be closed with surgery; however, most surgical procedures are considerably invasive in nature. The aim of this study was to evaluate the outcomes of minimally invasive myringoplasty using platelet-rich plasma (PRP) and an atelocollagen sponge for closure of chronic tympanic membrane perforations, as well as to identify the factors affecting the surgical outcome. Methods The records of 118 patients who underwent surgical closure of chronic tympanic membrane perforation at an ear–nose–throat clinic were reviewed retrospectively. After removing the margin of the perforation via a transcanal approach under local anesthesia, an atelocollagen sponge injected with PRP was inserted into the perforation as a scaffold. If the size of the perforation decreased after the surgery, the same surgical procedure was repeated. The success rate of closure after the last surgery was evaluated in terms of the size of the perforation. In addition, the relationships of the success rate with the cause and duration of perforation and patient age were also examined. Results The perforation was closed after initial or repeat surgeries in 95.8% (68/71) of cases with small-sized perforations, 80.0% (32/40) of cases with middle-sized perforations, and 85.7% (6/7) of cases with large-sized perforations. Multiple surgeries (up to four times) were required for middle- and large-sized perforations, and even for some small-sized perforations. The number of re-operations required for closure significantly increased with increase in the size of the perforation (Kruskal–Wallis test, p Conclusion Minimally invasive myringoplasty using PRP has a satisfactory success rate even for large-sized tympanic membrane perforations. PRP is autologous and its use is non-toxic and safe. Although informed consent from the patient is necessary for the repetition of the surgery and for patients older than 80 years, this technique appears to be a promising office-based procedure for closure of chronic tympanic membrane perforations.

FGF2 and EGF for the Regeneration of Tympanic Membrane: A Systematic Review.

Objective A systematic review was conducted to compare the effectiveness and safety of fibroblast growth factor-2 (FGF2) and epidermal growth factor (EGF) for regeneration of the tympanic membrane (TM). Methods The PubMed database was searched for relevant studies. Experimental and clinical studies reporting acute and chronic TM perforations in relation to two healing outcomes (success rate and closure time) and complications were selected. Results A total of 47 studies were included. Five experimental studies showed closure rates of 55%–100% with FGF2 compared with 10%–62.5% in controls for acute perforations. Five experimental studies showed closure rates of 30.3%–100% with EGF and 3.6%–41% in controls for chronic perforations. Two experimental studies showed closure rates of 31.6% or 85.7% with FGF2 and 15.8% or 100% with EGF. Nine clinical studies of acute large perforations showed closure rates of 91.4%–100% with FGF2 or EGF. Two clinical studies showed similar closure rates between groups treated with FGF2 and EGF. Seven clinical studies showed closure rates of 88.9%–100% within 3 months and 58%–66% within 12 months using FGF2 in repair of chronic perforations, but only one study showed a significantly higher closure rate in the saline group compared with the FGF2 group (71.4% vs. 57.5%, respectively, P = 0.547). In addition, three experimental studies showed no ototoxicity associated with FGF2 or EGF. No middle ear cholesteatoma or epithelial pearls were reported, except in one experimental study and one clinical study, respectively. Conclusions FGF2 and EGF showed good effects and reliable safety for the regeneration of TM. In addition, EGF was better for the regeneration of acute perforations, while FGF2 combined with biological scaffolds was superior to EGF for chronic perforations, but was associated with high rates of reperforation over time. Further studies are required to determine whether EGF or FGF2 is better for TM regeneration.