Healing Of Perforations Research Articles

SMILE lenticule versus amniotic membrane graft (AMG) augmented with platelet-rich plasma (PRP) for the treatment of perforated corneal ulcer.

To evaluate the safety and efficacy of stromal lenticule obtained from small-incision lenticule extraction (SMILE) surgery versus amniotic membrane graft (AMG) augmented with platelet-rich plasma (PRP) for the treatment of perforated corneal ulcers and compare the results between the two groups. This is a comparative retrospective study that included 40 eyes with medium-sized corneal perforations, which were classified into two equal groups of 20 eyes each; group (A) was treated with SMILE lenticule graft and group (B) was treated with AMG augmented with PRP. Pre- and postoperative evaluations were carried out using both slit-lamp (SL) examination and anterior segment optical coherence tomography (AS-OCT), including closure of perforation, complete healing, and best corrected visual acuity (BCVA). Complete closure of the perforation was achieved in both groups. However, healing was faster in the SMILE lenticule group than in the AMG with PRP group (P < 0.05). Complete healing was achieved inboth groups: 100% in SMILE lenticule group and 95% in AMG with PRP group (P > 0.05). Both groups had few insignificant complications (30% in each), which were managed. Both methods achieved adequate healing of corneal perforations within few weeks without significant complications. However, the stromal lenticule obtained from small-incision lenticule extraction (SMILE) surgery tended to be safer with faster healing than AMG with PRP.

Routine nasogastric tube placement in patients with small esophageal perforation after endoscopic foreign body removal may be unnecessary: a propensity score matching analysis.

Nasogastric tube (NGT) placement is part of the post-operative management of upper gastrointestinal perforation, but its routine use in esophageal perforation (EP) caused by foreign bodies remains unclear. The purpose of this research was to investigate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal. A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study. Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed. The perforation healing rate, post-operative adverse events, hospital stay, and death rate were analysed using a 1:1 propensity score matching model. Before matching, there were 263 patients in the NGT group and 60 patients in the non-NGT group. There were significant differences in the time to treatment, infection, albumin, and types of endoscopy between the two groups, while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group. After 1:1 propensity score matching, 48 pairs of patients were matched between the two groups. The perforation healing rate, post-operative adverse events, length of hospital stay, and death rate did not show significant differences between the two groups. For patients with small EP caused by foreign bodies, routine NGT placement after endoscopic foreign body removal may be unnecessary.

Efficacy of Human Epidermal Growth Factor in the Regeneration of Tympanic Membrane Perforation

Introduction: Majority of tympanic membrane perforations require myringoplasty for closure. Recently, epidermal growth factor (EGF) has been shown to promote the healing of tympanic membrane perforations. Aim: The aim of this study was to find out a simple nonsurgical outpatient procedure to close one-quadrant tympanic membrane perforations that could reduce the hospital stay, medical cost, and morbidity in these patients. Materials and Methods: An interventional prospective randomized clinical study was done on 120 patients at our tertiary hospital. The allocation ratio was 3:1. Pure-tone audiometry, otomicroscopy, and otoenodoscopic recording were performed in all eligible patients who consented to take part in the study. Ninety cases received EGF gel application, whereas 30 controls received antibiotic ofloxacin application. Trichloroacetic acid chemical cautery and fibrin glue application were done in patients of both groups. Results: The closure rate was 97.7% in the EGF group and 70% in the ofloxacin group. The time taken for closure of perforations was 10 to 14 days in the EGF group and 3–4 weeks in the ofloxacin group. Hearing gain was observed in healed perforations of both groups. Conclusion: EGF application enhances the healing effect of one-quadrant nonhealing tympanic membrane perforations. It showed encouraging results and reliable safety in the regeneration of tympanic membrane. Clinical Significance: Apart from its use in single quadrant perforation, EGF may be considered for treating residual perforations after failed tympanoplasty.

Comparative study on microscopic myringoplasty and endoscope assisted myringoplasty in a tertiary care centre in Kanyakumari district

Objective: To evaluate the efficacy of endoscopic myringoplasty and comparison with conventional myringoplasty. Materials and Methods: Sixty cases of clinically diagnosed chronic supportive otitis media with dry central perforation were taken into account of which 30 cases were undergone endoscopic myringoplasty and 30 cases undergone conventional myringoplasty. All patients were followed up on 3rd, 7th, 15th day, 6th weeks, 3rd and 6th months after surgery. Results: The tympanic membrane’s perforation healing rate was 86% (26/30), in conventional group of myringoplasty and 83% (25/30) in endoscopic group of myringoplasty and average hearing gain in conventional group was 13.96 dB and in endoscopic group was 15.03 dB. Conclusion: The surgical outcome of endoscope assisted myringoplasty in terms of graft uptake and hearing improvement was comparable to the conventional microscope assisted myringoplasty, but in terms of cosmesis and postoperative recovery patients in the endoscope group had better results.

Silk fibroin nanofiber scaffold (SFNS) as a graft material for myringoplasty- in vitro and in vivo

Tympanic membrane (TM) perforation repair or myringoplasty is one of the most common surgeries performed in ENT practice. This surgery uses graft materials such as temporalis muscle fascia, pinna cartilage, perichondrium, and even artificial materials such as silicone and polymers to restore the hearing mechanism in deaf people and stops ear discharge. Some disadvantages of this surgery include the requirement for complex microsurgical skills, high cost, graft site complications, and anesthesia-related risks. To overcome these drawbacks, a variety of bioengineered graft materials, such as polycaprolactone (PCL), silk polymers are being used. In this study, we used in vitro and in vivo investigations to assess the potential use of silk fibroin nanofiber scaffolds (SFNS) as a graft material. Cell proliferation, viability studies and DNA quantification tests were performed on rat primary TM epithelial cells and human mammary fibroblast (HMF) cells to evaluate SFNS in vitro. The results demonstrated that both rat primary TM epithelial cells and HMF cells are compatible with SFNS graft material and showed cell proliferation. The scanning electron microscopy (SEM) was used to image the rat primary TM epithelial cells on SFNS and found the cells integrated into SFNS, proving that the graft material is nontoxic. The in vivo experiments included creating TM perforations in Sprague Dawley rats and performing myringoplasty with SFNS as a graft. Five out of six rats demonstrated effective perforation healing, including evidence of neovascularization at the pars tensa, indicating that the SFNS is biocompatible and can be employed for TM perforation repair.

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;

The study of otoendoscopic tympanoplasty (type I)

Background With the development of otoendoscopic surgery technology and the update of equipment, more and more otoendoscopic tympanoplasty are carried out. Objectives To investigate application of otoendoscopic tympanoplasty. Methods Seventy-six patients with tympanic membrane perforation were randomly enrolled into otoendoscopic group (OP, n = 38) and microscope group (MP, n = 38). We compared two-group patients using operative time, intraoperative blood loss, healing of postoperative perforations, and degree of postoperative hearing improvement. Results Average operation time was statistically significant shorter in the OP than the MP (p < .05); the intraoperative blood loss in the OP was significant less than MP (p < .05); after postoperative follow-up, the healing rate of tympanic membrane perforation was 92.11% in the OP compared to 89.47% in the MP. However, there was no statistically significant difference in the two groups (p > .05). There were no statistically significant differences between the preoperative and postoperative air and bone conduction thresholds in the two groups (p > .05). Conclusions Otoendoscopic tympanoplasty is a minimally invasive operation but with similar effects as compared to microscopic one. But the operation time and intraoperative blood loss in the OP were significantly better than those in the MP, thus it is a safe, effective and easy to be operated in clinical practice.

Epidermal Growth Factor Application versus Observation on Healing of Acute Tympanic Membrane Perforations: A Randomized Open Label Clinical Trial

ABSTRACT Objective: To compare the effect of topical epidermal growth factor (EGF) instillation versus observation alone on healing of acute tympanic membrane perforations in terms of closure and hearing test results. Methods: Design: Randomized, Open label, Clinical Trial Setting: Tertiary Government Training Hospital Participants: Seventeen (17) ENT-HNS OPD patients aged between 18 to 65 years old diagnosed with acute tympanic membrane perforation were included in the study. Group A underwent observation while group B was treated with recombinant human EGF solution. Follow- up was on a weekly basis (7th, 14th, 21st and 28th days) where video otoscopy for documentation and measurement of perforation using ImageJTM software was done. Pure tone audiometry was used to compare hearing improvement pre and post study in both observation and treatment groups. Results: At baseline, there was no significant difference in the sizes of perforations: 24.20 ± 9.95 (treatment) vs. 32.64 ± 11.62 (observation) with a p-value of .131. Following treatment, mean changes in perforation size were significantly greater in the treatment group compared to the observation group from baseline to day 7 (M = -9.08, n = 15.11 vs. M = -1.06, n = 31.58); p = .009; day 7 to 14 (M = -6.37, n = 13.78 vs. M = -0.79, n = 30.79); p = .003; and from day 14 to 21 (M = -5.65, n = 10.89 vs. M = -0.72, n = 30.07); p = .004 but not from day 21 to 28 (M = -4.16, n = 13.99 vs. M = -0.36, n = 29.71; p = .021. From baseline pure tone averages, four participants with mild hearing loss and two with moderate hearing loss achieved normal hearing in the treatment group (while one each with moderate and severe hearing loss did not improve). None of the observation group participants had improved hearing. Conclusion: Based on our limited experience, topical EGF can be used for traumatic tympanic membrane perforation and otitis media with dry ear perforation during the acute phase or within 3 months of perforation.

Repair of the Murine Tympanic Membrane Displays Hallmarks of Regeneration

BackgroundThe tympanic membrane (TM) has a remarkable ability to repair itself, with perforations typically closing in days to weeks in all mammalian species studied. The cellular and molecular mechanisms underlying TM repair remain largely unknown, however. This study looked to thoroughly characterize the repair process of the injured TM and uncover mechanisms of repair to inform future treatments for TM disorders. We hypothesized that the TM does not undergo canonical “wound healing” but regenerates in response to injury.MethodsCells from TMs injured on adult mice 14, 7, 3, and 1 day prior to sacrifice were submitted for single‐cell RNA sequencing using the 10x Genomics scRNA‐seq platform. Using Seurat clustering and the CellFindR algorithm, unbiased cell clusters were generated with matrices of differentially expressed genes for each cluster. Protein detection via immunofluorescence (IF) and RNA detection via RNAscope were used to biologically validate and define the anatomic locations of distinct cellular populations. The K5Cre‐ERT2 promoter was utilized in mouse models to genetically manipulate and fluorescently label keratinocyte (KC) populations. The mTmG and Confetti reporters were utilized as fluorescent labels.ResultsRNA expression data from all timepoints of perforation were merged and analyzed, revealing 8 distinct major populations of cells and revealing time‐dependent transcriptional shifts in each layer of the TM. From both cross‐sectional and whole‐mount views, the TM shows a rapid, proliferative response to injury by 18 hours post‐injury, predominantly in the KCs. 3 days after perforation, there are large transcriptional shifts in the immune, mesenchymal, and mucosal populations. The multi‐layered tissue shows a large volumetric increase by day 7 but quickly remodels and restores the original volume of the TM by day 14. At slightly longer timepoints, the radial and circular collagen patterning of the TM is also restored, creating a scar‐free structure. We identified a regeneration‐induced “wounded epithelial” population, characterized by a combination of distinct marker genes. A K5Cre‐ERT2;Confetti mouse model shows that the population migrates from known stem cell regions of the organ to the site of injury. Based on expression values and immunostaining, EGFR signaling is upregulated during regeneration, corresponding with increased expression of EGFR ligands and processing co‐factors. When EGFR is deleted in vivo, using a K5‐CreERT2;Egfrfl/fl; R26mTmG/mTmG mouse model, TMs no longer display proliferation post‐injury and cannot repair perforations.ConclusionsTM perforation healing displays a complex and coordinated series of transcriptional, morphological, and patterning events, ultimately culminating in the restoration of normal tissue architecture to the TM. These characteristics are more typical of epimorphic regeneration, rather than more typical scar induced mammalian wound healing.

Novel Application of Photo-Crosslinked Urocanic-Acid-Modified Chitosan in Corneal Wounds.

In the last few years, the use of tissue adhesives in corneal perforation has gained immense popularity in clinical practices. The present study aimed to devise a new application of urocanic-acid-modified chitosan (CS) with methylene blue (MB) as a photosensitizer for the development of a photo-crosslinked tissue adhesive. In particular, the curing time was controlled with the aid of a 650 nm red diode. Under the same irradiation condition, the mechanical properties were tuned using the photosensitizer at different concentrations. In vitro tests revealed that the gel was ductile and biocompatible. The application of the gel to a perforated cornea model stopped the leakage of aqueous humor, immediately after the gel was photo-crosslinked. The blue appearance of the gel provided high precision when applied to corneal wounds. Importantly, the crosslinked gel became transparent within 24 h, owing to the dissipation of MB from tears, and the gel spontaneously sloughed off without artificial removal. Altogether, the study reported the development of a novel photo-crosslinkable urocanic-acid-modified CS gel that exhibited significant potential to be utilized in the healing of corneal perforation.

Microbiology of Chronic Otitis Media—A Review

Chronic otitis media (COM) is a major health problem in the world, particularly in the underdeveloped and developing countries. COM is typically persistent, insidious in onset, and usually capable to manifest deafness and otorrhea. The common microorganisms isolated from COM include Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Bacteroides. Otorrhea and healing of the tympanic membrane perforation in COM is a virtuous circle of events detected by the classic sequence of acute inflammatory change. In COM, a vicious circle occurs when incomplete healing predisposes the ear to further acute episodes, and these occur so frequently that they merge and are seen as continuous and chronic. Conservative medical treatment of COM is required to control active otorrhea. Effective treatment of COM needs a thorough knowledge of causative microorganisms and their antibacterial sensitivity. The appropriate identification of microorganisms and timely administration of antibiotics in COM patients ensure prompt clinical recovery and avoid possible complications. Bacterial predominance and sensitivity to antibiotics have changed over time, so these need periodic surveillance for guiding the appropriate antibacterial therapy. Early and effective treatment is based on the knowledge of causative microorganisms, and their antimicrobial sensitivity that ensures the prompt clinical recovery and possible complications of COM. The objective of this review article is to discuss the prevalence, bacteriology, treatment, and bacterial resistance in COM.

Topical Administration of Carvacrol Improves Healing in Nasal Septal Perforation: An Experimental Animal Study.

Clinicians are exploring alternative treatments for nasal septum perforation since surgical treatment is challenging. The effects of topical carvacrol on the healing of nasal septal perforation were investigated in an animal model. Twenty-one male New Zealand rabbits were randomly divided into three equal groups. A 5-mm circular biopsy punch was used to perforate the nasal septum behind the columella. For 14 days, bilateral gelatin sponges impregnated with carvacrol in olive oil in group 1, and only olive oil in group 2 were placed. Perforation only was performed in the control group. Animals were then sacrificed, and their nasal septums were removed. The closure of the perforation was measured, and samples were examined histopathologically. MMP-9 reactivity was evaluated using the immunoperoxidase technique. Histopathologic parameters were scored as 0 = none, 1 = mild, 2 = moderate, and 3 = strong. The septum perforation closure in the carvacrol group was statistically significant compared with the other groups (p < 0.001). Cartilage regeneration, connective tissue density, and MMP-9 immunoreactivity were significantly higher in the carvacrol group (p = 0.020, p = 0.009, and p = 0.008, respectively). Topically administered carvacrol enhances wound healing in rabbit nasal septum perforation. It accelerated perforation closure by increasing cartilage regeneration, connective tissue, and MMP-9 expression.

Plasminogen-Loaded Fibrin Scaffold as Drug Delivery System for Wound Healing Applications.

Plasminogen is a protein involved in intravascular and extravascular fibrinolysis, as well as in wound healing, cell migration, tissue formation and angiogenesis. In recent years its role in healing of tympanic perforations has been demonstrated in plasminogen deficient mice. The aim of this work was to fabricate a fibrin-based drug delivery system able to provide a local and sustained release of plasminogen at the wound site. Initially, the biological activity of plasminogen was evaluated by in vitro experiments on cell cultures. A metabolic assay (MTT) was carried out on L929 mouse fibroblast to determine the concentration that does not affect cell viability, which turned out to be 64 nM. The effect of plasminogen on cell migration was evaluated through a scratch test on human keratinocytes: cells treated with 64 nM plasminogen showed faster scratch closure than in complete medium. Fibrin scaffold loaded with plasminogen was fabricated by a spray process. SEM analysis showed the typical nano-fibrillar structure of a fibrin scaffold. Tensile tests highlighted significantly higher value of the ultimate stress and strain of fibrin scaffold with respect to fibrin clot. The in-vitro release kinetic showed an initial plasminogen burst, after that the release slowed, reaching a plateau at 7 days. Plasminogen-loaded fibrin scaffold applied in full-thickness diabetic mouse lesions showed a significantly higher closure rate at 14 days than scaffold used as a reference material. Histological analysis demonstrated an improved reepithelization and collagen deposition in granulation tissue in mouse treated with plasminogen-loaded fibrin scaffold in comparison to unloaded fibrin scaffold. The obtained results demonstrated the suitability of the fibrin scaffold loaded with plasminogen as drug delivery system and suggest its use in wound healing applications, such as for the treatment of chronic diabeticulcers.

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.

Role of healing promoting factors in healing of tympanic membrane perforations

Background and Aim Some healing promoting factors, such as epidermal growth factor (EGF), fibroblast growth factor (FGF), hyaluronic acid (HA), and platelet-rich plasma (PRP), have been in use nowadays to assist healing eardrum perforations. Several trials have been conducted to assess their effectiveness. This meta-analysis was conducted to find out the prognostic effects of these factors. Materials and methods The search methods consist of electronic databases and literature references for published and unpublished studies, besides the reference lists of all relevant studies. Selection criteria All types of studies (randomized controlled trials, prospective, retrospective, or case–control). Data collection and analysis Eighteen articles were included after screening by titles and/or abstracts and full-text assessment. They were categorized according to the used healing promoting factor. Data were extracted and analyzed via Cochrane Collaboration's Review Manager Software. Results EGF and FGFs significantly improved the rate of closure, healing duration, and increased hearing gain. On the contrary, the overall effects of HA and PRP were nonsignificant in this respect. Conclusion EGF and FGF can increase the rate of closure of tympanic membrane perforations, shorten healing duration, and improve hearing gain. PRP and HA do not have a significant effect. This can be attributed to heterogeneity of the studies included to assess the role of each of these two factors.

Safety and Efficacy of Nonoperative Treatment in Esophageal Perforation Caused by Foreign Bodies.

INTRODUCTION:Esophageal foreign bodies are often treated by endoscopy, but the treatment of esophageal perforation caused by foreign bodies remains controversial. The purpose of this study was to investigate the safety and efficacy of nonoperative treatment of esophageal perforation caused by foreign bodies.METHODS:We retrospectively analyzed 270 patients admitted to our hospital for esophageal perforation caused by foreign bodies from January 2012 to December 2020, all of whom received nonoperative treatment.RESULTS:The mean age of the patients was 56 ± 17 years, and fish bones were the most common type of foreign body. A total of 61.2% of the perforations were in the cervical esophagus. All patients received nonoperative treatment initially, and the foreign body removal rate using endoscopy reached 97%. The perforation healing rate reached 94.8%, whereas 3 patients (1.1%) died during hospitalization. The median (range) duration of hospitalization was 4 days (3–6). Multivariable analysis showed age ≥ 66 years (odds ratio [OR]: 2.196; 95% confidence interval [CI]: 1.232–3.916; P = 0.008), men (OR: 1.934; 95% CI: 1.152–3.246; P = 0.013), and time to treatment (OR: 1.126; 95% CI: 1.027–1.233; P = 0.011) were independent risk factors for infection, whereas the risk of infection was lower when the foreign body type was fish bone (OR: 0.557; 95% CI: 0.330–0.940; P = 0.028).DISCUSSION:Nonoperative treatment is safe and effective for esophageal perforation caused by foreign bodies. Even if perforation is combined with infection, active nonoperative treatment can still achieve a good effect. Early intervention can effectively reduce the risk of infection and improve patient outcomes.

COMPARISON BETWEEN TRAGAL CARTILAGE WITH PERICHONDRIUM AND TEMPORALIS FASCIA GRAFT BY UNDERLAY ENDOSCOPIC TYMPANOPLASTY

Objective: To compare the results of tragal cartilage with perichondrium versus temporalis fascia graft in endoscopic tympanoplasty using underlay technique.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Study conducted in Tertiary Care Hospital, Karachi, from Jul 2018 to Feb 2020.&#x0D; Methodology: Overall, 34 patients having permanent unilateral tympanic membrane perforations were included in this study, in whom underlay endoscopic tympanoplasty was performed. Group A patients underwent temporalis fascia graft while group B received a tragal cartilage with perichondrium graft. The success rate between groups was compared in respect of reduction in postoperative air-bone gap and healing of perforation.&#x0D; Results: The success rate of graft was 88% (30/34) in group A and 94% (32/34) in group B after 6 months follow-up, the difference was not found to be statistically significant (p=0.368). Hearing improvement in the form of closure of air bone gap in group A was from 24.52 ± 1.73 dB (decibel) to 13.56 ± 5.67s dB and in group B it was from 19.76 ± 3.47dB to 11.94 ± 3.9dB, the difference was not significant statistically (p=0.333).&#x0D; Conclusion: Keeping in view the results of our study, we conclude that both tragal cartilage with perichondrium and temporalis fascia graft are considered equally successful in endoscopic tympanoplasty.

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

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. 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. 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. 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. 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.

The Effect of Topical Insulin on Healing of Small Central Tympanic Membrane Perforations and Hearing Threshold

The Effect of Topical Insulin on Healing of Small Central Tympanic Membrane Perforations and Hearing Threshold

Morphological and Molecular Evaluation of the Tissue Repair following Nasal Septum Biopsy in a Sheep Model.

Nasal septal pathologies requiring surgical intervention are common in the population. Additionally, nasal chondrocytes are becoming an important cell source in cartilage tissue engineering strategies for the repair of articular cartilage lesions. These procedures damage the nasal septal cartilage whose healing potential is limited due to its avascular, aneural, and alymphatic nature. Despite the high incidence of various surgical interventions that affect septum cartilage, limited nasal cartilage repair characterizations have been performed to date. To evaluate the healing of the nasal septum cartilage perforation, a septal biopsy was performed in 14 sheep. Two and 6 months later, the tissue formed on the place of perforation was explanted and compared with the native tissue. Tissue morphology, protein and gene expression of explanted tissue was determined using histological, immunohistochemical and real-time quantitative polymerase chain reaction analysis. Tissue formed on the defect site, 2 and 6 months after the biopsy was characterized as mostly connective tissue with the presence of fibroblastic cells. This newly formed tissue contained no glycosaminoglycans and collagen type II but was positively stained for collagen type I. Cartilage-specific genes COL2, AGG, and COMP were significantly decreased in 2- and 6-month samples compared with the native nasal cartilage. Levels of COL1, COL4, and CRABP1 genes specific for perichondrium and connective tissue were higher in both test group samples in comparison with native cartilage. Newly formed tissue was not cartilage but rather fibrous tissue suggesting the role of perichondrium and mucosa in tissue repair after nasal septum injury.