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Kanemaru SI, Kita SI, Kanai R, Yamaguchi T, Kumazawa A, Yuki R, Yoshida M, Miwa T, Harada H, Maetani T. Tympanic Membrane Regeneration Therapy for Pediatric Tympanic Membrane Perforation. Otol Neurotol 2024; 45:1030-1036. [PMID: 39165098 DOI: 10.1097/mao.0000000000004285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2024]
Abstract
OBJECTIVE To evaluate tympanic membrane regeneration therapy (TMRT) for pediatric tympanic membrane perforations (TMPs). STUDY DESIGN Intervention study. SETTING Research institute hospital. PATIENTS In this study, 20 patients with chronic TMP (M/F: 13/7, 13/8 ears, age 0-15 years) treated with TMRT were evaluated. As comparison, 20 pediatric patients with chronic TMP who underwent myringoplasty/tympanoplasty were included. INTERVENTIONS For the TM repair procedure, the edge of the TMP was disrupted mechanically, and gelatin sponge immersed in basic fibroblast growth factor was placed inside and outside the tympanic cavity and covered with fibrin glue. The TMP was examined 4 ± 1 weeks later. The protocol was repeated up to four times until closure was complete. MAIN OUTCOME MEASURES Closure of the TMP and hearing improvement were evaluated at 16 weeks after the final regenerative procedure. Adverse events were monitored. RESULTS The mean follow-up period was 427.1 days. The TM regenerated in all cases, but pinhole reperforation occurred in two cases, and the final closure rate was 90.5% (19 of 21). Hearing improved to 24.9 ± 7.6 dB on average before surgery and to 13.8 ± 5.4 dB after surgery. The AB gap improved from 12.9 ± 8.0 to 5.2 ± 3.5 dB.The myringoplasty/tympanoplasty group had significantly lower AB gap improvement compared with the TMRT group. There were no adverse events. CONCLUSIONS TMRT can be expected to regenerate near-normal TMs with a high closure ratio, resulting in better-hearing improvement compared with the myringoplasty/tympanoplasty group, and is an effective treatment for children with long life expectancy.
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Affiliation(s)
| | - Shin-Ichiro Kita
- Department of Otolaryngology and HNS, Hearing Disturbance and Eardrum Regeneration Center, Medical Research Institute, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan
| | - Rie Kanai
- Department of Otolaryngology and HNS, Hearing Disturbance and Eardrum Regeneration Center, Medical Research Institute, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan
| | - Tomoya Yamaguchi
- Department of Otolaryngology and HNS, Hearing Disturbance and Eardrum Regeneration Center, Medical Research Institute, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan
| | - Akiko Kumazawa
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ryohei Yuki
- Department of Otolaryngology and HNS, Hearing Disturbance and Eardrum Regeneration Center, Medical Research Institute, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan
| | - Misaki Yoshida
- Department of Otolaryngology and HNS, Hearing Disturbance and Eardrum Regeneration Center, Medical Research Institute, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan
| | - Toru Miwa
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Hiroyuki Harada
- Department of Otolaryngology and HNS, Hearing Disturbance and Eardrum Regeneration Center, Medical Research Institute, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan
| | - Toshiki Maetani
- Department of Otolaryngology and HNS, Hearing Disturbance and Eardrum Regeneration Center, Medical Research Institute, Kitano Hospital, Public Interest Incorporated Foundation, Tazuke Kofukai, Osaka, Japan
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Xue H, Chen S, Hu Y, Huang J, Shen Y. Advances in 3D printing for the repair of tympanic membrane perforation: a comprehensive review. Front Bioeng Biotechnol 2024; 12:1439499. [PMID: 39188376 PMCID: PMC11345550 DOI: 10.3389/fbioe.2024.1439499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/19/2024] [Indexed: 08/28/2024] Open
Abstract
Tympanic membrane perforation (TMP) is one of the most common conditions in otolaryngology worldwide, and hearing damage caused by inadequate or prolonged healing can be distressing for patients. This article examines the rationale for utilizing three-dimensional (3D) printing to produce scaffolds for repairing TMP, compares the advantages and disadvantages of 3D printed and bioprinted grafts with traditional autologous materials and other tissue engineering materials in TMP repair, and highlights the practical and clinical significance of 3D printing in TMP repair while discussing the current progress and promising future of 3D printing and bioprinting. There is a limited number of reviews specifically dedicated to 3D printing for TMP repair. The majority of reviews offer a general overview of the applications of 3D printing in the broader realm of tissue regeneration, with some mention of TMP repair. Alternatively, they explore the biopolymers, cells, and drug molecules utilized for TMP repair. However, more in-depth analysis is needed on the strategies for selecting bio-inks that integrate biopolymers, cells, and drug molecules for tympanic membrane repair.
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Affiliation(s)
- Hao Xue
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Shengjia Chen
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
| | - Yi Hu
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Juntao Huang
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yi Shen
- Ningbo Institute of Innovation for Combined Medicine and Engineering, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, Zhejiang, China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, China
- Centre for Medical Research, Ningbo No.2 Hospital, Ningbo, Zhejiang, China
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Wang Y, Zhao J, Wu J, Ren T, Wu Y. Comparison of side effects of different steroids used in intratympanic injections. Am J Otolaryngol 2024; 45:104258. [PMID: 38513512 DOI: 10.1016/j.amjoto.2024.104258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/17/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVES This study aimed to compare the side effects of different steroids used in the intratympanic injections (IT). METHODS One hundred and sixty patients diagnosed with sudden sensorineural hearing loss and undergoing IT were assigned to four groups based on the type or concentration of steroids administered (Group DM5: 5 mg/ml Dexamethasone sodium phosphate; Group DM10: 10 mg/ml Dexamethasone sodium phosphate; Group MP: 40 mg/ml Methylprednisolone sodium succinate; Group BM: 4 mg/ml Betamethasone sodium phosphate). Each group comprised 40 patients, and all participants received IT six times. The study assessed and compared the degrees and duration of pain, dizziness, and tympanic membrane damage following IT. Patients were asked to report the pain they felt using the numeric rating scale (NRS). RESULTS NRS scores for pain after IT showed significant differences among the four groups (p < 0.001). The average NRS scores for pain in each group were as follows: Group DM5: 1.53 ± 1.04; Group DM10: 1.45 ± 1.30; Group MP: 4.33 ± 2.22; Group BM: 6.03 ± 1.46. The durations of pain after IT also exhibited significant differences among the four groups (p < 0.001), with the longest duration observed in Group MP at 31.93 ± 15.20 min. CONCLUSION Different types of steroids could lead to varying degrees of pain when used in IT. Betamethasone could cause the most severe pain, and methylprednisolone could result in the longest duration of pain.
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Affiliation(s)
- Yi Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - Jieli Zhao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; Vertigo and Balance Disorder Center, Eye & ENT Hospital, Fudan University, Shanghai 200031, China
| | - Juejing Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - Tongli Ren
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - Yongzhen Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai 200031, China; NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China.
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Lou Z, Lou Z, Lv T, Chen Z. Outcomes of perichondrium graft covering the epithelium of the tympanic membrane for large-sized perforations: A 3-5-year follow-up study. Am J Otolaryngol 2024; 45:104121. [PMID: 38056195 DOI: 10.1016/j.amjoto.2023.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 11/19/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the graft outcomes and iatrogenic cholesteatomas for 3 years following cartilage-perichondrium over-underlay technique with perichondrial graft covering the epithelium for large-sized tympanic membrane (TM) perforations. MATERIALS AND METHODS This prospective case series enrolled patients with large-sized perforation who underwent endoscopic cartilage-perichondrium over-underlay technique. The graft success rate, hearing outcomes, and development of iatrogenic middle ear cholesteatomas and graft cholesteatomas were assessed at 3 years postoperatively. RESULTS This study included 62 ears of 62 patients. The mean follow-up duration was 47.3 ± 10.8 (38-64) months. Neovascularization was observed in the lateral perichondrium graft in 55 (88.7 %) patients, which inosculated into the TM remnant at 4-5 weeks. However, graft neovascularization was not observed in the four patients with excessive perichondrium graft that migrated into the external auditory canal and the three patients with middle ear infections. The graft failure rate was 6.5 % at 6 months, 11.3 % at 12 months, 6.5 % at 24 months, and the overall graft success rate was 91.8 % at the last follow-up. Granular myringitis developed in 11.3 % (7/62) of the patients. High-resolution computed tomography revealed well-pneumatized mastoids and middle ear at the final follow-up. However, graft cholesteatomas were observed in 3 (4.8 %) patients at 7-24 months postoperatively. CONCLUSIONS The cartilage-perichondrium over-underlay technique with perichondrial graft covering TM epithelium is safe and effective for the repair of large perforations, with good short- and long-term graft outcomes, minimal risk of graft cholesteatoma development, and no risk of iatrogenic middle ear cholesteatomas.
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Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang provice, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China
| | - Tian Lv
- Department of Otorhinolaryngology, Wenzhou Medical University Affiliated Yiwu Hospital, 699 Jiangdong Road, Yiwu city 322000, Zhejiang provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China; Department of Otolaryngology Head and Neck Surgery & Center of Sleep Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Yishan Road 600, 200233 Shanghai, China; Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, 200233 Shanghai, China; Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, 200233 Shanghai, China.
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Kim YH, Park HJ, Yoo JH. Effect of eardrum perforation and chronic otitis media on the results of infrared tympanic thermometer in adults: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e35932. [PMID: 37960811 PMCID: PMC10637521 DOI: 10.1097/md.0000000000035932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND This study was conducted to determine whether tympanic membrane perforation or chronic otitis media affects the results of an infrared tympanic membrane thermometer in adults. METHODS A literature search was performed using PubMed, Embase, Cochrane Library, Web of Science, and Google Scholar. RESULTS Four nonrandomized studies were included in the analysis. The temperatures of the bilateral eardrums (one eardrum with normal condition [control group] and the other eardrum with perforation or chronic otitis media [experimental group]) were measured for the same subject in the studies. The mean and standard deviation of the bilateral tympanic membrane temperatures were used to calculate the mean difference (MD) with a corresponding 95% confidence interval (CI). The fixed-effect model was utilized based on the results of the heterogeneity measurement using the Chi2 test and I2 statistic. The results of a meta-analysis in the normal eardrum (control group) and perforated eardrum, chronic suppurative otitis media with tympanic membrane perforation, or chronic otitis media with cholesteatoma (experimental group) were 343 subjects (MD = 0.05; 95% CI = -0.00 to 0.11; P = .06). A meta-analysis of the normal eardrum (control group) and perforated eardrum or chronic suppurative otitis media with tympanic membrane perforation except for cholesteatoma (experimental group) found 296 subjects (MD = 0.05; 95% CI = -0.01 to 0.11; P = .10). CONCLUSION When the temperatures of the bilateral eardrums were measured using an infrared tympanic membrane thermometer, no difference was observed between the eardrum with perforation or chronic otitis media and the normal eardrum.
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Affiliation(s)
- Yee-Hyuk Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Catholic University School of Medicine, Daegu, Korea
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Hee-Jun Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Catholic University Medical Center, Daegu, Korea
| | - Jae-Ho Yoo
- Department of Otorhinolaryngology-Head & Neck Surgery, Daegu Catholic University Medical Center, Daegu, Korea
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Incidence and Epidemiology of Traumatic Tympanic Membrane Rupture: A National Trauma Data Bank Analysis. J Craniofac Surg 2023; 34:168-172. [PMID: 36190699 DOI: 10.1097/scs.0000000000009013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 08/08/2022] [Indexed: 12/31/2022] Open
Abstract
The incidence of traumatic tympanic membrane rupture (TTMR) has increased over recent decades. The association of certain external injury causes and bone fracture patterns with TTMR is anecdotal. It has been suggested that a diagnosis of TTMR may be missed during the acute trauma admission. The authors sought to evaluate the incidence of TTMR according to external injury cause and evaluate the association of skull fracture patterns with TTMR using a national trauma database. A cross-sectional analysis of trauma encounters was conducted using the National Trauma Data Bank (NTDB) from 2008 to 2015. Demographic and injury data were abstracted. Poisson regression was used to determine the incidence rate ratios of tympanic membrane rupture by external injury cause and logistic regression was used to estimate odds ratios (OR) of TTMR by skull fracture type. A total of 8214 patients were identified with TTMR during acute admission. The majority were on average 30 years old, 76% male, 71% White, had a mean Injury Severity Score of 14, and 42% were admitted to level I centers. The incidence rate ratio was only higher in lightning related injuries [5.262; 95% confidence interval (CI): 4.194-6.602] when using those caused by explosives as a reference. Basilar skull (OR: 12.95; 95% CI: 12.095-12.866) and cranial vault (OR: 2.938; 95% CI: 2.647-3.260) fractures were most associated with TTMR. The high incidence TTMR in association with certain external causes of injury and types of skull fractures should drive screening in the acute setting in order to increase detection and reduce morbidity from missed injuries.
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Muacevic A, Adler JR, Khizer MA, Hussain A, Safoor I, Jamal A. Relationship of Hearing Loss and Tympanic Membrane Perforation Characteristics in Chronic Suppurative Otitis Media Patients. Cureus 2022; 14:e32496. [PMID: 36644044 PMCID: PMC9837494 DOI: 10.7759/cureus.32496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/15/2022] Open
Abstract
Objective The objective of this study is to assess the relationship between the site of tympanic membrane (TM) perforation and the type and degree of hearing impairment. The secondary objective was to compare the duration of the disease and the degree of hearing loss. Study design This is a prospective observational study. Place and duration of the study This study was carried out in the Department of Otolaryngology/Head and Neck Surgery at the Pakistan Institute of Medical Sciences, Islamabad, from May 2021 to April 2022. Patients and methods Of all the screened patients, 77 fulfilled the inclusion criteria. Patients aged 10-40 years with inactive mucosal chronic otitis media and unilateral perforation in one quadrant were included. The site of TM rupture was observed, and audiometric analysis was performed. Results The mean age of participants was 25 ± 8.61 years, with a preponderance of the female gender (57.1%). A total of 32 (41.6%), 19 (24.7%), 19 (24.7%), and seven (9.1%) perforations involved posterosuperior, anterosuperior, anteroinferior, and posteroinferior quadrants respectively. Conductive, mixed, and sensorineural hearing loss was found in 52 (67.5%), 18 (23.4%), and seven (9.1%) cases, respectively. Of all the subjects, 13 (16.9%) had the disease for < one year, 39 (50.6%) for one to five years, 17 (22.1%) for five to 10 years, and eight (10.4%) for > 10 years. There was a statistically significant association between the degree of hearing loss and the site of perforation. No significant association was found between the site of perforation and the type of hearing loss. Duration of disease and degree of hearing loss also had no significant association. Conclusion The extent of hearing loss was found to be directly influenced by the anatomical site of perforation, with the posterosuperior quadrant perforation producing the greatest degree of impairment.
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Araújo ES, Jacob LCB, Oliveira MTDD, Chaves JN, Oliveira EB, Saters TL, Alvarenga KDF. Wideband absorbance for the assessment of pressure equalizing tubes patency in children. Int J Pediatr Otorhinolaryngol 2022; 162:111309. [PMID: 36099781 DOI: 10.1016/j.ijporl.2022.111309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/27/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To analyze the feasibility of using wideband absorbance to verify the patency of pressure equalizing tubes (PETs) in clinical practice and to present the response pattern of this measure for ears with patent PET. METHODS This observational case-control type study evaluated 48 ears of 30 children with severe or profound hearing loss, aged 10-44 months, of both sexes. The subjects were subdivided into two groups: 24 ears with Sheppard type PET (experimental group - EG) and 24 ears with normal middle ear (control group - CG), paired with the EG, according to age, sex, and ear evaluated. To obtain the wideband absorbance, a Middle-Ear Power Analyzer, version 5.0 (Mimosa Acoustics), was used, and absorbance values for pure tone and chirp stimuli were analyzed. RESULTS There was no influence of ear (right or left) on the measurements obtained. The EG showed higher absorbance values at low frequencies. Although the two stimuli made it possible to identify the difference in acoustic transfer function between the groups studied, compared to pure tone, the chirp stimulus allowed identification of differences in a higher number of frequencies. CONCLUSIONS Ears with a patent PET present an acoustic transfer pattern that differs from that obtained for normal middle ears, with a higher absorbance at low frequencies. Both pure tone and chirp stimuli can be used to identify such differences, nevertheless, the use of chirp stimulus is recommended, since it allows differentiation over a wider frequency range.
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Affiliation(s)
- Eliene Silva Araújo
- Department of Speech-Language Pathology and Audiology, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
| | - Lilian Cassia Bornia Jacob
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry / University of São Paulo, FOB / USP, Bauru, São Paulo, Brazil
| | - Maria Taiany Duarte de Oliveira
- Graduate Program in Speech, Language and Hearing Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Juliana Nogueira Chaves
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - Eduardo Boaventura Oliveira
- Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo (USP), Bauru, São Paulo, Brazil
| | - Thais Lenharo Saters
- Graduate Program in Speech, Language and Hearing Sciences, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | - Kátia de Freitas Alvarenga
- Department of Speech-Language Pathology and Audiology, Bauru School of Dentistry / University of São Paulo, FOB / USP, Bauru, São Paulo, Brazil
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