1
|
Singh AP, Singh S, Malik R. A Post-marketing Surveillance, Single-Centric Study to Evaluate the Safety and Tolerability of VELNEZ as a Space-Occupying Dressing Pack After Ear Surgery. Cureus 2024; 16:e51732. [PMID: 38318579 PMCID: PMC10839627 DOI: 10.7759/cureus.51732] [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: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
PURPOSE The purpose of this study was to evaluate the safety and tolerability of VELNEZ (Datt Mediproducts Pvt. Ltd., New Delhi, India) as a space-occupying dressing for controlling hemorrhage after ear surgery. METHOD A total of 21 patients were included in an open-label, interventional, single-arm post-marketing surveillance study to investigate the safety and efficacy of the VELNEZ ear pack. The patients were questioned for collecting data related to the subject's safety and comfort, adverse events, site assessment, and otoscopic examination from discharge day to last follow-up (eight follow-up visits) at regular intervals. The standardized questionnaires for VELNEZ tolerability (pain/pressure effect, infection, and general satisfaction) were used after ear surgery. RESULTS The average hemorrhage control time was 1.08 ± 0.16 minutes. None of the subjects reported moderate pain at any of the study visits following surgery. This biodegradable ear pack had an average disintegration time of 25.4 days in the ear cavity. No postoperative adverse events or serious adverse events were observed. CONCLUSION VELNEZ is safe and effective as a space-occupying dressing pack after ear surgery and is well-tolerated by patients.
Collapse
Affiliation(s)
- Akhil P Singh
- Department of Otolaryngology - Head and Neck Surgery, Sarojini Naidu Medical College, Agra, IND
| | - Saloni Singh
- Department of Otolaryngology - Head and Neck Surgery, Sarojini Naidu Medical College, Agra, IND
| | - Ridhima Malik
- Department of Otolaryngology - Head and Neck Surgery, Sarojini Naidu Medical College, Agra, IND
| |
Collapse
|
2
|
Lou Z, Lou Z, Yu D, Wang J, Lv T, Chen Z. Comparison of endoscopic over-underlay technique with and without packing for repairing chronic perforation. Eur Arch Otorhinolaryngol 2022; 279:4761-4768. [PMID: 35038027 DOI: 10.1007/s00405-022-07254-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/03/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS At 12 months 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 ± 2.1 min in the packing and no-packing groups, respectively (P < 0.001). CONCLUSIONS 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.
Collapse
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, Zhejiang Province, 322000, China.
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Dongzhen Yu
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Jingjing Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China
| | - Tian Lv
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, Zhejiang Province, 322000, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
- Department of Otolaryngology Head and Neck Surgery and Center of Sleep Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.
- Otolaryngological Institute of Shanghai Jiao Tong University, Yishan Road 600, Shanghai, 200233, China.
- Shanghai Key Lab Sleep Disordered Breathing, Yishan Road 600, Shanghai, 200233, China.
| |
Collapse
|
3
|
Tang Y, Lou Z, Lou Z, Jin K, Sun J, Chen Z. Is no de-squamatization of the TM reliable for cartilage over-underlay myringoplasty without external auditory canal packing? Am J Otolaryngol 2021; 42:103064. [PMID: 33892227 DOI: 10.1016/j.amjoto.2021.103064] [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: 02/28/2021] [Revised: 03/31/2021] [Accepted: 04/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We evaluated the graft and hearing outcomes of patients with chronic perforations treated via the cartilage-perichondrium over-underlay technique without de-squamatization of the TM and external auditory canal (EAC) packing. MATERIALS AND METHODS Thirty-nine patients with chronic perforations and residual tympanic membranes around the perforation margins were treated using the cartilage-perichondrium over-underlay technique without de-squamatization of the TM and EAC packing. Patients were followed-up for 6 months. RESULTS For all 39 patients with unilateral perforations, the graft success rate was 100% (39/39) at 6 months after surgery. The mean air-bone gap significantly (P < 0.05) improved from 13.41 ± 8.34 dB preoperatively to 7.45 ± 3.81 dB postoperatively in patients with small and medium perforations; the mean air-bone gap significantly improved from 20.57 ± 9.41 dB preoperatively to 9.84 ± 2.41 dB postoperatively in patients with large perforations. The lateral perichondrium gradually became necrotic and crust at postoperative 2-3 months and migrated into the EAC in all patients. CONCLUSIONS The cartilage-perichondrium over-underlay myringoplasty without de-squamatization of the TM and EAC packing is feasible, affording a high graft success rate and good hearing improvement. The lateral perichondrium may gradually become necrotic and crusted, and migrate along the EAC over time.
Collapse
Affiliation(s)
- Yongmei Tang
- Department of Pathology, Yiwu Central Hospital, Yiwu City 322000, Zhejiang Provice, China
| | - Zihan Lou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City 322000, Zhejiang Provice, China.
| | - Kangfeng Jin
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City 322000, Zhejiang Provice, China
| | - Junzhi Sun
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu City 322000, Zhejiang Provice, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China; Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai 200233, China.
| |
Collapse
|
4
|
Bawazeer N, Zaouche S, Tringali S, Fieux M. Is gelfoam sealing necessary in stapes surgery? Acta Otolaryngol 2021; 141:231-236. [PMID: 33283573 DOI: 10.1080/00016489.2020.1849794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Sealing the oval window around the piston after fenestration with Gelfoam® is a common practice in stapes surgery for otosclerosis. OBJECTIVES To analyse the effect of using or not using Gelfoam® as a sealing material. METHODS A retrospective study was performed on 418 patients who underwent stapes surgery from 2013 until 2019. Data were collected from medical records in a tertiary centre. 215 cases in the Gelfoam group and 203 cases in the control group without sealing were included. The main comparisons were made between these two groups in terms of vestibular (primary outcome) and audiological outcomes and complications. RESULTS The patients' mean age was 47 years with a mean follow up of 50 months and a female predominance (65.6%, p = .049). There was no significant difference in terms of postoperative vertigo (11.6% vs 8.4%) or audiological outcomes in between Gelfoam and control group respectively. The average postoperative air-bone gap in the Gelfoam group was 4.6 dB vs. 5.3 dB in the control group (p = .634). CONCLUSION AND SIGNIFICANCE No difference were identified in vestibular or audiological outcomes during stapes surgery when using or not using Gelfoam® in the middle ear.
Collapse
Affiliation(s)
- Naif Bawazeer
- Department of Otolaryngology-Head & Neck Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Sandra Zaouche
- Department of Otolaryngology, and Otoneurosurgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Stéphane Tringali
- Department of Otolaryngology, and Otoneurosurgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Maxime Fieux
- Department of Otolaryngology, and Otoneurosurgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
5
|
Lou Z. Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty in adhesive perforation: retrospective case series. Acta Otolaryngol 2021; 141:14-18. [PMID: 32921208 DOI: 10.1080/00016489.2020.1814406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The adhesive perforation could be the sequela of adhesive otitis media, that partial tympanic membrane remnant is bound completely to the medial wall of the middle ear by fibrous adhesions. However, few studies have reported on the repairing of adhesive perforation. OBJECTIVES To evaluate the long-term outcome of endoscopic full-thickness cartilage-perichondrium double graft myringoplasty for adhesive perforation. MATERIALS AND METHODS In total, 26 patients with unilateral adhesive perforation associated with chronic otitis media who underwent full-thickness cartilage-perichondrium double graft myringoplasty were included. Outcomes were evaluated in terms of the hearing gain and graft success rate at 12 and 24 months. RESULTS The graft success rate was 96.15% (25/26) at 12 months and 88.46% (23/26) at 24 months. The neovascularization and epithelium covering the lateral surface of the cartilage graft were seen at preoperative 4 weeks, the superficial cartilage graft got complete epithelialization within 4-6 months. CT revealed the well-pneumatized middle ear and mastoid cells at postoperative 24th months in all the patients, no middle ear cholesteatoma formation and keratin pearls were found during the period of follow up. CONCLUSIONS Endoscopic full-thickness cartilage-perichondrium double graft myringoplasty without the tympanomeatal flap elevation is a feasible method for repairing adhesive perforations, with a higher graft success rate and satisfactory hearing results.
Collapse
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, affiliated Yiwu Hospital of Wenzhou Medical University (Yiwu Central Hospital), Yiwu City, Zhejiang Province, China
| |
Collapse
|
6
|
Effect of middle ear gelfoam on hearing and healing process after tympanoplasty: A prospective randomized case-control study. Am J Otolaryngol 2021; 42:102767. [PMID: 33166858 DOI: 10.1016/j.amjoto.2020.102767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE This prospective randomized case-control study was performed to compare the surgical outcomes of our swing-door overlay tympanoplasty with or without absorbable gelatine sponge (AGS, gelfoam) packing in the middle ear cavity, according to the surgical procedure. METHODS Fifty-seven patients who underwent swing-door overlay tympanoplasty by a single surgeon were enrolled in the study. The data of 30 patients of the gelfoam-packing group (GPG) and 27 patients of the non-gelfoam-packing group (NGPG) were prospectively collected and compared. RESULTS Closure of the tympanic membrane was found to be successful in all patients at postoperative 3 months evaluation. NGPG showed a statistically better healing process compared to GPG; earlier epithelialization and less fascia edema in NGPG than in GPG (P < 0.05). The air-bone gap (ABG) measured at postoperative 1 and 2 months was smaller in NGPG than GPG, although there were no statistical differences. CONCLUSION This study revealed earlier healing process and faster recovery of ABG in NGPG, thereby indicating that the gelfoam in the middle ear may interfere with both hearing recovery and the healing process of neodrum.
Collapse
|
7
|
Lou Z. Comparison of biodegradable synthetic polyurethane foam versus Gelfoam packing in cartilage graft myringoplasty procedures. Auris Nasus Larynx 2020; 47:976-981. [DOI: 10.1016/j.anl.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/24/2020] [Accepted: 06/08/2020] [Indexed: 12/28/2022]
|
8
|
Lou Z. An ideal biodegradable material for repairing the tympanic membrane perforations following ventilation tube. Int J Pediatr Otorhinolaryngol 2020; 134:110050. [PMID: 32330772 DOI: 10.1016/j.ijporl.2020.110050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, 699 Jiangdong Road, Yiwu City, 322000, Zhejiang provice, China.
| |
Collapse
|
9
|
Lou Z. The Effect of External Auditory Canal Packing Duration on Healing After Endoscopic Cartilage Myringoplasty. EAR, NOSE & THROAT JOURNAL 2020; 100:656-661. [PMID: 32339051 DOI: 10.1177/0145561320922117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The external auditory canal (EAC) packing is widely used in otosurgery and is considered to promote hemostasis and to support tympanic membrane grafts. However, few studies have investigated the effects of packing removal time on healing. OBJECTIVE We investigated the effect of EAC packing duration on healing after endoscopic cartilage myringoplasty in patients with chronic tympanic membrane perforations (TMPs). MATERIALS AND METHODS Patients with chronic TMPs who underwent endoscopic "push-through" cartilage myringoplasty were divided into early and late groups based on the length of time before EAC packing was removed. The graft success rate, eardrum appearance, and hearing gain were assessed 3 months after surgery. RESULTS The study included 137 patients. Three months after surgery, the graft success rate was 83.5% (66/79) in the early group and 94.8% (55/58) in the late group (P = .042). The graft was displaced in 8 (10.1%) patients in the early group and in 1 (1.7%) patient in the late group (P = .050). No epithelialization was found on the surface of the grafts in the early group, whereas epithelialization was nearly complete 4 weeks after surgery in the late group. CONCLUSIONS Delaying removal of the EAC packing after endoscopic cartilage myringoplasty may promote tympanic membrane better healing and cartilage graft epithelialization and improve the appearance of the eardrum.
Collapse
Affiliation(s)
- Zhengcai Lou
- Department of Otorhinolaryngology, Yiwu Central Hospital, Yiwu, Zhejiang, China
| |
Collapse
|
10
|
Wang D, Ren T, Wang W. The outcomes of endoscopic myringoplasty: packing with gelatin sponge versus packing with nothing. Acta Otolaryngol 2020; 140:292-296. [PMID: 31961238 DOI: 10.1080/00016489.2020.1714075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Packing with gelatin sponge has long been widely used in myringoplasty. However, there is no research on packing with nothing.Aims/objectives: To analyse the differences between packing with gelatin sponge and packing with nothing.Material and methods: Patients with tympanic membrane perforation were randomly divided into a packing with gelatin sponge group and a packing with nothing group. Differences between the groups were compared.Results: The operation time of group A (34.00 ± 1.05 min) was significantly shorter than that of group B (42.20 ± 1.40 min; p < .00); 1 patient (2.86%) in group A and 35 patients (100%) in group B had a dry ear time of longer than 1 week (p < .001). Ten patients (28.57%) in group A and 24 patients (68.57%) in group B had aural fullness after the operation (p < .001). The air-bone gap (ABG) in group A was smaller than that in group B at 1 week, 1 month, 2 months and 3 months after the operation (p < .05).Conclusion and significance: Group A achieved the same good results, but it had a short operation time, an early dry ear time, a low incidence of aural fullness and early recovery of hearing.
Collapse
Affiliation(s)
- Dan Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| | - Tongli Ren
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| | - Wuqing Wang
- ENT Institute and Otorhinolaryngology Department, Affiliated Eye and ENT Hospital, Fudan University and Key Laboratory of Hearing Medicine of National Health and Family Planning Commission (NHFPC), Shanghai, China
| |
Collapse
|
11
|
Lou ZC. Endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal to repair marginal perforations. J Otolaryngol Head Neck Surg 2020; 49:13. [PMID: 32143701 PMCID: PMC7060568 DOI: 10.1186/s40463-020-00408-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
Objective To evaluate the graft success rate and postoperative hearing gain for marginal perforations using endoscopic cartilage myringoplasty with the removal of a small rim of the external auditory canal (EAC). Study design Prospective case series. Materials and methods We performed a prospective study in 41 patients with marginal perforations who underwent endoscopic cartilage myringoplasty with the removal of a small rim of EAC. Patients were followed up for 6 months. Results Of the 41 patients with unilateral marginal perforation included in this study, the graft success rate was 100% (41/41). The mean ABG improved from 11.31 ± 9.71 dB preoperatively to 7.31 ± 2.32 dB postoperatively for small-and medium-sized perforations (P = 0.13); the mean ABG improved from 21.46 ± 8.39 dB preoperatively to 9.84 ± 2.41 dB postoperatively for large perforations (P < 0.05); the mean ABG improved from 28.79 ± 6.74 dB preoperatively to 10.13 ± 3.56 dB postoperatively for subtotal and total perforations (P < 0.05). There were no cases of graft lateralization or significant blunting or atelectasis or graft adhesions. Three patients developed postoperative otorrhoea and five patients had mild myringitis. Conclusions Endoscopic cartilage myringoplasty with the removal of a small rim of the EAC is simple and feasible, showing a high graft success rate and minimal complications for repairing marginal perforations.
Collapse
Affiliation(s)
- Zheng-Cai Lou
- Department of Otorhinolaryngology, Yiwu central Hospital, 699 jiangdong road, Yiwu city, 322000, Zhejiang provice, China.
| |
Collapse
|
12
|
Singh SP, Xia A, Tusty M, Victorovich Malkovskiy A, Easwaran M, Zarabanda D, Valdez TA. Identification of early inflammatory changes in the tympanic membrane with Raman spectroscopy. Analyst 2019; 144:6721-6728. [PMID: 31612878 DOI: 10.1039/c9an01772k] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The tympanic membrane (TM) is a dynamic structure that separates the middle ear from the external auditory canal. It is also integral for the transmission of sound waves. In this study, we demonstrate the feasibility of using Raman spectroscopy to identify early chemical changes resulting from inflammation in the TM that can serve as an indicator of acute otitis media. Bacterial lipopolysaccharide (LPS) was injected trans-tympanicaly in a murine model. Presence of inflammatory response was assessed with binocular microscopy, confirmed with histopathology and immunofluorescence staining. Successful discrimination suggesting spectral differences among the control and LPS treated groups was achieved using principal component analysis. Raman imaging revealed major differences in collagen distribution and nucleic acid content. Image segmentation analysis on the trichrome stained tissue sections was performed to corroborate the Raman spectra. The spectral co-localization study suggests changes in the expression of collagen IV specific signals in LPS treated samples. The overall findings of the study support prospective application of RS in the diagnosis and therapeutic monitoring of otitis media.
Collapse
Affiliation(s)
- S P Singh
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94305, USA.
| | - Anping Xia
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94305, USA.
| | - Mahbuba Tusty
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94305, USA.
| | | | - Meena Easwaran
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94305, USA.
| | - David Zarabanda
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94305, USA.
| | - Tulio A Valdez
- Department of Otolaryngology and Head and Neck Surgery, School of Medicine, Stanford University, Palo Alto, CA 94305, USA.
| |
Collapse
|
13
|
Deniz B, Oguzhan KR, Erdem O, Hasan S, Fuat YY, Muge O. The effects of different packing materials on healing and hearing after trauma to middle ear mucosa, an experimental study in rats. Am J Otolaryngol 2019; 40:347-352. [PMID: 30685188 DOI: 10.1016/j.amjoto.2019.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare the performance of Spongostan, Otopore, Spongostan soaked with dexamethasone and Spongostan soaked with Hyaluronic acid (HA) as middle ear packing material after mucosal trauma. METHODS Twenty rats were divided into 4 groups. In control group (group 1), the middle ear cavities of animals were bilaterally packed with Spongostan; in group 2, with Otopore; in group 3, with Spongostan soaked with dexamethasone; and in group 4, with Spongostan soaked with HA. Auditory brainstem responses (ABRs) were performed preoperatively and 1 and 6 weeks postoperatively. Histological analyses were performed to evaluate the inflammatory reaction and wound healing in the middle ear cavity. RESULTS ABR recordings demonstrate that threshold level changes from baseline were minor in Otopore and Spongostan soaked with dexamethasone packed ears. Threshold levels were higher in the Spongostan and Spongostan soaked with HA packed ears compared with both Otopore and Spongostan soaked with dexamethasone packed ears. Histological analyses showed that Spongostan caused inflammation more intense than Otopore and Spongostan soaked with dexamethasone. Residual material at postoperative week 6, new bone formation and adhesion were common in the Spongostan group compared with other groups. Fibrosis was more common in Spongostan group compared with other groups but the difference was not significant. CONCLUSION Otopore appears to be safe and effective for use in otologic surgery. The inflammation, adhesion and new bone formation decreased when Spongostan was used with steroid or HA, when compared to Spongostan alone.
Collapse
Affiliation(s)
- Baklaci Deniz
- Numune Training and Research Hospital, Department of Otolaryngology, Ankara, Turkey.
| | - Kum Rauf Oguzhan
- Numune Training and Research Hospital, Department of Otolaryngology, Ankara, Turkey
| | - Ozdemir Erdem
- Mehmet Akif Inan Training and Research Hospital, Department of Pathology, Sanliurfa, Turkey
| | - Sahin Hasan
- Guven Private Hospital, Department of Audiology, Ankara, Turkey
| | - Yilmaz Yavuz Fuat
- Gulhane Training and Research Hospital, Department of Otolaryngology, Ankara, Turkey
| | - Ozcan Muge
- Numune Training and Research Hospital, Department of Otolaryngology, Ankara, Turkey
| |
Collapse
|
14
|
Alvi SA, Nelson-Brantley J, Staecker H. Alginate Ototoxicity in the Mouse Model. Otolaryngol Head Neck Surg 2018; 159:733-738. [PMID: 29759021 DOI: 10.1177/0194599818775951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To determine whether alginate exposure to the round window of the mouse causes any measurable ototoxicity. Study Design Prospective animal study. Setting Basic science laboratory affiliated with a tertiary care university medical center. Subjects and Methods After Institutional Animal Care and Use Committee approval, 5 adult mice were obtained and underwent bullostomy and round window niche application of alginate. Auditory brainstem response (ABR) tests were completed at baseline prior to the procedure and also 5, 14, and 30 days postprocedure. Results were compared. At termination of procedure, the mice were sacrificed with harvest of the cochleae, which were viewed under histologic section. Results There were no significant increases in ABR thresholds in any of the test animals at all test periods after alginate exposure compared to baseline. There were also no observable behavioral changes after the procedure to indicate vestibular dysfunction. Cochlear sectioning revealed no evidence of histologic damage. Conclusion Exposure of alginate to the round window does not cause any obvious ototoxicity in the mouse model. Further clinical trials will be needed to elucidate the effect of alginate in the human middle ear.
Collapse
Affiliation(s)
- Sameer A Alvi
- 1 Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Jennifer Nelson-Brantley
- 2 Auditory & Vestibular Neuroscience Lab, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Hinrich Staecker
- 1 Department of Otolaryngology, University of Kansas Medical Center, Kansas City, Kansas, USA.,2 Auditory & Vestibular Neuroscience Lab, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
15
|
Jin ZH, Dong YH, Lou ZH. The effects of fibroblast growth factor-2 delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic eardrum perforations lying close to the malleus. Am J Otolaryngol 2017; 38:582-587. [PMID: 28606657 DOI: 10.1016/j.amjoto.2017.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 05/17/2017] [Accepted: 06/04/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We evaluated the effects of fibroblast growth factor-2 (FGF-2) delivered via a Gelfoam patch on the regeneration of myringosclerotic traumatic tympanic membrane perforations (TMPs) lying close to the malleus. STUDY DESIGN A prospective, randomized, controlled clinical study. SETTING A university-affiliated teaching hospital. SUBJECTS AND METHODS We prospectively analyzed, in a randomized manner, the outcomes of treatment for traumatic TMPs constituting >25% of the tympanic membrane. The closure rates, closure times, and otorrhea rates were compared among patients treated via FGF-2-containing Gelfoam patches, Gelfoam patches alone, and observation only. RESULTS We analyzed data from 138 patients. The perforation closure rates in the FGF-2 plus Gelfoam patch, Gelfoam patch, and observation alone groups were 97.9, 89.8, and 70.7%, respectively. Both the FGF-2 plus Gelfoam and Gelfoam alone groups exhibited significantly higher closure rates than the observational group (both p<0.05).The mean closure times were 15.7±5.1, 24.8±4.9, and 35.7±9.2days in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. The FGF-2 plus Gelfoam patch group exhibited a significantly shorter closure time than the Gelfoam patch alone and observation alone groups (p<0.05). The incidences of purulent otorrhea were 14.6, 6.1, and 4.9% in the FGF-2 plus Gelfoam patch, Gelfoam patch alone, and observation alone groups, respectively. Surprisingly, 7 of 7 (100.0%) perforations associated with purulent otorrhea completely closed in the FGF-2 plus Gelfoam patch group; however, no such perforation healed in either the Gelfoam alone or observation alone group. CONCLUSIONS FGF-2 plus Gelfoam patching significantly shortened the closure time compared to observation and Gelfoam patching alone, and it significantly improved the closure rate (compared to observation alone) of myringosclerotic perforations lying close the malleus. FGF-2 plus Gelfoam patching is a valuable, minimally invasive alternative treatment that may be readily applied to outpatient settings.
Collapse
Affiliation(s)
- Zhong-Hai Jin
- Department of Medicine, YiWu Central Hospital, Yiwu city 322000, Zhejiang Province, China
| | - Yi-Han Dong
- Department of Otolaryngology, Daqing Oilfield Genaral Hospital, Daqing City 163001, Heilongjiang Province, China
| | - Zi-Han Lou
- Department of Clinical Medicine, Xinxiang Medical University, Xinxiang City 453003, Henan Province, China.
| |
Collapse
|
16
|
Salihoglu M, Dogru S, Cesmeci E, Caliskan H, Kurt O, Kuçukodaci Z, Gungor A. Ototoxicity of boric acid powder in a rat animal model. Braz J Otorhinolaryngol 2017; 84:332-337. [PMID: 28479241 PMCID: PMC9449159 DOI: 10.1016/j.bjorl.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/23/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Boric acid, which has antiseptic and acidic properties, is used to treat external and middle ear infections. However, we have not found any literature about the effect of boric acid powder on middle ear mucosa and inner ear. Objective The purpose of this study is to investigate possible ototoxic effects of boric acid powder on cochlear outer hair cell function and histological changes in middle ear mucosa in a rat animal model. Methods Twenty healthy, mature Wistar albino rats were used in this study. The rats were divided into two groups, Group A and Group B, each of which consisted of 10 rats. Initially, the animals in each group underwent distortion product otoacoustic emissions testing of their right and left ears. After the first distortion product otoacoustic emissions test, a surgical microscope was used to make a small perforation in both ears of the rats in each group, and a second distortion product otoacoustic emissions test was used to measure both ears in all of the rats. Boric acid powder was applied to the right middle ear of the rats using tympanic membrane perforation, and the distortion product otoacoustic emissions were measured immediately after the boric acid powder application. The histological changes and distortion product otoacoustic emissions were evaluated three days later in Group A and 40 days later in Group B. Results No significant differences were found at all of the distortion product otoacoustic emissions frequencies. In Group A, mild inflammation of the middle ear mucosa was found on the third day after boric acid powder application. In Group B, boric acid powder caused mild inflammatory changes on the 40th day, which declined over time. Those changes did not lead to significant fibrosis within the mucosa. Conclusion In rats, boric acid powder causes mild inflammation in middle ear mucosa and it has no ototoxic effects on cochlear outer hair cell function in the inner ear of rats.
Collapse
Affiliation(s)
- Murat Salihoglu
- GATA Haydarpasa Training Hospital, Department of Otorhinolaryngology, Istanbul, Turkey.
| | - Salim Dogru
- Efes Otolaryngology Branch Center, Department of Otorhinolaryngology, Izmir, Turkey
| | - Enver Cesmeci
- Diyarbakir Military Hospital, Department of Otorhinolaryngology, Diyarbakir, Turkey
| | - Halil Caliskan
- Eskisehir Military Hospital, Department of Otorhinolaryngology, Eskisehir, Turkey
| | - Onuralp Kurt
- Erzincan Military Hospital, Department of Otorhinolaryngology, Erzincan, Turkey
| | - Zafer Kuçukodaci
- GATA Haydarpaşa Training Hospital, Department of Pathology, Istanbul, Turkey
| | - Atila Gungor
- GATA Haydarpasa Training Hospital, Department of Otorhinolaryngology, Istanbul, Turkey
| |
Collapse
|
17
|
Perez E, Hachem RA, Carlton D, Bueno I, Vernon S, Van De Water TR, Angeli SI. Comparison of packing material in an animal model of middle ear trauma. Am J Otolaryngol 2016; 37:323-9. [PMID: 27061143 DOI: 10.1016/j.amjoto.2016.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the performance of absorbable gelatin sponge (AGS) with polyurethane foam (PUF) as middle ear packing material after mucosal trauma. MATERIALS AND METHODS Using a randomized, controlled and blinded study design fifteen guinea pigs underwent middle ear surgery with mucosal trauma performed on both ears. One ear was packed with either PUF or AGS while the contralateral ear remained untreated and used as non-packed paired controls. Auditory brainstem response (ABR) thresholds were measured pre-operatively and repeated at 1, 2, and 6weeks postoperatively. Histological analysis of middle ear mucosa was done in each group to evaluate the inflammatory reaction and wound healing. Another eighteen animals underwent middle ear wounding and packing in one ear while the contralateral ear was left undisturbed as control. Twelve guinea pigs were euthanized at 2weeks postoperatively, and six were euthanized at 3days post-operatively. Mucosal samples were collected for analysis of TGF-β1 levels by enzyme-linked immunosorbent assay. RESULTS ABR recordings demonstrate that threshold level changes from baseline were minor in PUF packed and control ears. Threshold levels were higher in the AGS packed ears compared with both control and PUF packed ears for low frequency stimuli. Histological analysis showed persistence of packing material at 6weeks postoperatively, inflammation, granulation tissue formation, foreign body reaction and neo-osteogenesis in both AGS and PUF groups. TGF-β1 protein levels did not differ between groups. CONCLUSION PUF and AGS packing cause inflammation and neo-osteogenesis in the middle ear following wounding of the mucosa and packing.
Collapse
|
18
|
Lou ZC, Tang YM, Chen HY, Xiao J. The perforation margin phenotypes and clinical outcome of traumatic tympanic membrane perforation with a Gelfoam patch: our experience from a retrospective study of seventy-four patients. Clin Otolaryngol 2016; 40:389-92. [PMID: 25639704 DOI: 10.1111/coa.12386] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Z C Lou
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical College, Zhejiang, China
| | - Y M Tang
- Department of pathology, The Affiliated YiWu Hospital of Wenzhou Medical College, Zhejiang, China
| | - H Y Chen
- Department of Otorhinolaryngology, The Affiliated YiWu Hospital of Wenzhou Medical College, Zhejiang, China
| | - J Xiao
- Molecular Pharmacology Research Center, School of Pharmacy, Wenzhou Medical University, Zhejiang, China
| |
Collapse
|
19
|
Seo YJ, Kim SH, Moon IS, Choi JY. A melting method for RNA extraction from the mucosal membrane of the mouse middle ear. Yonsei Med J 2015; 56:497-502. [PMID: 25684001 PMCID: PMC4329364 DOI: 10.3349/ymj.2015.56.2.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE There is much confusion surrounding the methods of RNA extraction from the middle ear mucosa of mice. In this study, we worked to develop a "melting method," which is faster, purer, and more reliable than other methods in common use. MATERIALS AND METHODS Thirty-two ears were used for this study. Light microscopy with hematoxylin-eosin staining of the bullae, scanning electron microscopy (SEM), spectrophotometer analysis, and reverse transcription polymerase chain reaction were performed before and after melting the half lateral bullae, which were detached from the temporal bone by using a lateral retroauricular approach. RESULTS Each resected half bulla contained a well distributed mucosal membrane. After a TRIzol melting duration of 10-30 minutes, only mucosal marker (MUC5AC) was expressed without bony marker (total osteocalcin). The same results were determined from SEM. CONCLUSION This melting method, compared with stripping and irrigation methods, is effective and offers an easier, more robust approach to extracting RNA from the middle ear mucosal membranes of mice.
Collapse
Affiliation(s)
- Young Joon Seo
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Huhn Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - In Seok Moon
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Young Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
20
|
Abstract
CONCLUSIONS No significant subepithelial healing differences were found between Gelfoam and polyurethane foam (PUF). However, levels of hyperplasia of the mucosal lining and inflammation were lower with PUF packing. PUF packing is not feasible as a middle ear packing material for abraded mucosa. Further studies are required before clinical application. OBJECTIVE To date, there have been few reports on the antiadhesive effect of PUF as a middle ear packing. The purpose of this study was to investigate the antiadhesive effect of PUF soaked with saline in an animal model of mucosal trauma. METHODS Bioresorbable PUF soaked with saline was placed over abraded mucosa in the experimental group (n = 7), and compressed Gelfoam soaked with saline was placed in the control group (n = 7). After measurement of auditory brainstem responses (ABRs), the animals were sacrificed 3 weeks after packing placement for histological observation. RESULTS The ABR results at postoperative week 3 showed no statistically significant difference between the preoperative and post-packing values. An adhesion pattern with subepithelial thickening was observed in the control group. Adhesion was not observed in the experimental group; however, subepithelial fibrous thickening was noted.
Collapse
Affiliation(s)
- Cheol Hee Choi
- Department of Pharmacology, Bio New Drug Development, Chosun University , Gwangju
| | | |
Collapse
|
21
|
Goncalves S, Chiossone-Kerdel JA, Bianco AS, Ercolino JM, Hernandez-Rojas J. Effect of absorbable gelatin sponge in the middle ear: in vitro and in vivo animal model. Acta Otolaryngol 2015; 135:14-25. [PMID: 25496177 DOI: 10.3109/00016489.2014.951455] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION GelitaSpon gelatin sponge (GS) showed faster reabsorption than gelfoam (GF) in vitro, and GS-packed middle ears resulted in a faster hearing recovery and less inflammation than the ears packed with GF soaked in saline. Soaking GF sponges with boric acid (BA) appeared to offset the inflammatory response of saline-soaked GF, making this inflammatory response comparable to that of GS-packed ears. OBJECTIVE To describe the reabsorption and inflammatory effects of absorbable gelatin sponge in the middle ear. METHODS For in vitro evaluation, GF and GS were used as disks immersed in saline solution or 3% BA and placed in gel. Images were captured with a microscope and processed using image processing Toolbox. For in vivo tests, 16 female albino Sprague Dawley rats were divided into four groups: bulla opening; GF + 0.9% saline; GF + BA; and GS + 0.9% saline. An anterior approach to the right bulla was used for surgery. Preoperative and postoperative auditory brainstem response thresholds were measured. RESULTS In vitro, there was marked degradation of GF by day 14, while GS showed complete degradation by the third day. In vivo, hearing recovery occurred by day 21. GF produced a more severe inflammatory response, which could be reduced by treating the GF with BA.
Collapse
Affiliation(s)
- Stefania Goncalves
- Experimental Neurophysiology Laboratory, Universidad Central de Venezuela (UCV) School of Medicine, Ciudad Universitaria , Caracas
| | | | | | | | | |
Collapse
|
22
|
Eren E, Başoğlu MS, Kulduk E, Şimsek F, İnan S. Mucosal trauma induced apoptosis in guinea pig middle ear: comparision of hemostatic agents. Int J Pediatr Otorhinolaryngol 2014; 78:2222-8. [PMID: 25458164 DOI: 10.1016/j.ijporl.2014.10.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/05/2014] [Accepted: 10/10/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The aim of this study is to compare the effects of the absorbable gelatin sponge (AGS), microporous polysaccharide hemospheres (MPH), and Ankaferd on wound healing after middle ear trauma and to evaluate their ototoxicity in an experimental guinea pig model. METHODS Middle ear mucosal trauma was created in 21 healthy adult guinea pigs. MPH, Ankaferd, and AGS were applied into the right tympanic bulla of the guinea pigs (7 ears for each treatment modality). The left ears of the seven animals were used as the sham group. At the fourth postoperative week (28-30 days), the guinea pigs were decapitated. Apoptosis was investigated, and the expression of Bcl-xl, Apaf, p53, cytochrome 3, and caspase 3 were evaluated. RESULTS The Ankaferd and AGS groups demonstrated significantly lower epithelial thickness, inflammation, and capillary dilatation than did the control group (p<0.001, <0.001, /0.001, <0.001/, 0.005, and 0.005, respectively). A statistically significant decrease in Bcl-xl staining was observed in the middle ears of animals treated with MPH (p=0.003). There was significantly higher caspase 3 expression in the Ankaferd and AGS groups than in the control group (p<0.001 and p=0.002, respectively). CONCLUSION Light microscopy indicates that Ankaferd and AGS create less inflammation and increased caspase expression, which seems to induce inflammatory cell apoptosis. Ankaferd seems to be a promising hemostatic agent in otology.
Collapse
Affiliation(s)
- Erdem Eren
- İzmir Katip Çelebi University Atatürk Research and Education Hospital, Otolaryngology Head and Neck Surgery Clinic, İzmir, Turkey.
| | - Mehmet Sinan Başoğlu
- İzmir Aliağa State Hospital, Otolaryngology Head and Neck Surgery Clinic, İzmir, Turkey
| | - Erkan Kulduk
- Mardin State Hospital, Otolaryngology Head and Neck Surgery Clinic, Mardin, Turkey
| | - Fatma Şimsek
- İzmir Katip Çelebi University, Faculty of Medicine, Department of Histology and Embrology, İzmir, Turkey
| | - Sevinç İnan
- Celal Bayar University, Faculty of Medicine, Department of Histology and Embrology, Manisa, Turkey
| |
Collapse
|
23
|
OTO-201: nonclinical assessment of a sustained-release ciprofloxacin hydrogel for the treatment of otitis media. Otol Neurotol 2014; 35:459-69. [PMID: 24518407 PMCID: PMC4867991 DOI: 10.1097/mao.0000000000000261] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
HYPOTHESIS OTO-201 can provide sustained release to the middle ear and effectively treat otitis media, when compared with FDA-approved ciprofloxacin otic drop formulations. BACKGROUND There is an unmet medical need for antibiotic therapy that can provide a full course of treatment from a single administration by an otolaryngologist at the time of tympanostomy tube placement, obviating the need for twice daily multiday treatment with short-acting otic drops. METHODS Studies in guinea pigs and chinchillas were conducted. OTO-201 was administered as a single intratympanic injection and compared with the twice daily multi-day treatment with Ciprodex or Cetraxal otic drops. RESULTS OTO-201 demonstrated sustained release of ciprofloxacin in the middle ear compartment for days to approximately 2 weeks depending on the dose. The substantial C(max) values and steady drug exposure yielded by OTO-201 were in contrast to the pulsatile short lasting exposure seen with Ciprodex and Cetraxal. OTO-201 was also effective in a preclinical chinchilla model of Streptococcus pneumoniae-induced otitis media. The degree of cure was comparable to that afforded by Ciprodex and Cetraxal. There was no evidence of middle or inner ear pathology in guinea pigs treated with OTO-201, unlike Ciprodex and Cetraxal, which both demonstrated mild cochlear ototoxicity. No adverse effects of the poloxamer 407 vehicle were noted. CONCLUSION Intratympanic injection of OTO-201 constitutes an attractive treatment option to twice daily multiday dosing with ciprofloxacin ear drops for the treatment of otitis media, as evidenced by superior middle ear drug exposure, efficacy in an acute otitis media model, safety of administration, and convenience of a single dose regimen.
Collapse
|
24
|
Histological analysis of the effects of anti-adhesive haemostatic agents on the middle ear of the guinea pig. The Journal of Laryngology & Otology 2014; 128:885-91. [PMID: 25264149 DOI: 10.1017/s0022215114001571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Adhesion formation is a frequent and serious post-operative problem in ENT surgery. This study assessed the effect of two anti-adhesive haemostatic agents on an experimental guinea pig model. MATERIALS AND METHODS The middle-ear mucosa of 14 guinea pigs was exposed to surgical trauma. After surgery, Arista™ AH was injected into the right middle ear of seven animals, while Ankaferd Blood Stopper was injected into the right middle ear of the other seven animals. The left ears were left untreated and regarded as the control group. The three groups were compared by histological examination at post-operative week 4. RESULTS In each of the three groups, consolidation of the lamina propria and epithelium mucosae, increments in the number of active fibroblasts, collagen fibrils and inflammatory cells, and increased vascular dilation were observed on haematoxylin and eosin-stained sections, and were more prominent in the control and Ankaferd Blood Stopper groups. Epithelial thickness and capillary vasodilation were significantly lower in the Arista™ AH group compared with the control and Ankaferd Blood Stopper groups (p < 0.008). CONCLUSION Arista™ AH may prevent the formation of adhesions in middle-ear surgery. Further experimental studies are required to determine its ototoxic potential.
Collapse
|
25
|
Middle ear packing materials: comparison between absorbable hemostatic gelatine sponge and sugarcane biopolymer sponge in rats. Braz J Otorhinolaryngol 2014; 80:237-44. [PMID: 25153109 PMCID: PMC9535480 DOI: 10.1016/j.bjorl.2013.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 01/14/2014] [Indexed: 11/24/2022] Open
Abstract
Introduction Several biomaterials can be used in ear surgery to pack the middle ear or support the graft. The absorbable gelatin sponge is the most widely used, but it may produce fibrosis and impair ventilation of the middle ear. Objective This experimental study aimed to investigate the inflammatory effects of the sugarcane biopolymer sponge (BP) in the rat middle ear compared with absorbable gelatin sponge (AGS). Materials and methods Prospective experimental study design. Thirty adult female Wistar rats were allocated to receive the BP sponge into the right ear and AGS into the left ear. Animals were randomly killed at 4 and 12 weeks post-procedure. Qualitative histological assessments were performed to evaluate the inflammatory reaction in the tympanic bullae. Results The BP sponge caused inflammation more intense and persistent than AGS. The BP was not absorbed during the experiment. Fibrosis was observed only in the ears with AGS. There were thickening of the mucosa and neoangiogenesis in the group of AGS. Conclusion Despite inflammation, the BP sponge produced less fibrosis and neoangiogenesis compared to AGS. The sponge BP appeared to be a non-absorbable biomaterial in the middle ear.
Collapse
|
26
|
Olmos-Zuñiga JR, González-López Md R, Gaxiola-Gaxiola Md M, Cristerna-Sánchez Md L, Villalba-Caloca Phd J, Baltazares-Lipp Bs M, Soda-Merhy Md A, Hernández-Jiménez C, Jasso-Victoria Md R. Effects of middle ear packing with collagen polyvinylpyrrolidone and hyaluronic acid in guinea pigs. J INVEST SURG 2012; 25:398-404. [PMID: 23215797 DOI: 10.3109/08941939.2012.671902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate otoscopic and microscopic changes produced on the healthy mucosa of the middle ear (ME) and tympanic membrane (TM) of guinea pigs after packing with a collagen polyvinylpyrrolidone (CPVP) sponge soaked in hyaluronic acid (HA). MATERIAL AND METHODS In 24 guinea pigs, myringotomy on the right side was created and the ME was packed as follows: Group I (n = 6): Absorbable gelatin sponge (AGS) soaked in saline solution; Group II (n = 6): AGS sponge soaked in HA, Group III (n = 6): CPVP sponge soaked in saline solution, Group IV (n = 6): CPVP sponge soaked in HA. Four weeks after miringotomy, the ME and TM integrity and residual packing material were evaluated otoscopically. Histologically, we evaluated inflammatory changes on the ME mucosa. RESULTS All animals in Groups I and II showed residual packing material (p < .001 ANOVA, TUKEY). Histologically, more inflammation was observed in Groups I, II, and III than in Group IV (p < .001 ANOVA, TUKEY). Group IV showed greater fibroblastic reaction (p < .02, ANOVA, TUKEY) versus other groups. CONCLUSION The CPVP sponge soaked in HA used as ME packing material is biocompatible and nontoxic, because it produces minimal inflammatory changes on the healthy mucosa of the ME and TM of guinea pigs. However, more research with injured mucosa is needed to validate its usefulness in otosurgery.
Collapse
Affiliation(s)
- J Raúl Olmos-Zuñiga
- Department of Surgical Research, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Tahar Aissa J, Hultcrantz M. Healing of laser-induced tympanic membrane perforations in rats: no contribution of granulocyte colony-stimulating factor or Gelfoam. Int J Pediatr Otorhinolaryngol 2012; 76:963-8. [PMID: 22498142 DOI: 10.1016/j.ijporl.2012.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 03/05/2012] [Accepted: 03/07/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To study whether granulocyte colony-stimulating factor together with Gelfoam (absorbable gelatin sponge, USP) could enhance the healing of freshly perforated tympanic membranes. The frequency and occurrence of different immunocompetent cells and collagen types was noted. METHODS Laser perforations were made in the tympanic membrane of rats that were sacrificed at different time intervals post-myringotomy: Day 1, 3, 6, and 12. Tympanic membrane specimens were embedded and sections were stained with hematoxylin/eosin and an immunohistochemical technique was used, with antibodies against macrophages, B-cells, T-cells, and type I-IV collagens. Semi-quantification was performed after counting positive cells, mean values were calculated and analyzed statistically. RESULTS All perforations, except one, had closed by Day 12 and no difference was observed between experimental and control ears at the other time points. Gelfoam was still present in a high amount at Day 12. The sections were initially stained positive for type I and II collagen, but after Day 6, the regenerating tissue stained positive for mainly type III and IV collagens. Results showed that the recruitment of macrophages, B-cells, and T-cells could not be mapped with a statistical significance. CONCLUSIONS This study showed that at 6-12 days post-laser myringotomy, type III and IV collagen has replaced the collagen type II that normally constitutes the healthy tympanic membrane. There is a concern for excessive scarring involving adjacent structures. It was also seen that the combination of Gelfoam and granulocyte colony-stimulating factor or saline did not affect the healing times in perforated tympanic membranes. No significant results regarding the inflammatory cell recruitment could be obtained on the studied time points or between experimental and control ears, except for in the Gelfoam matrix.
Collapse
Affiliation(s)
- J Tahar Aissa
- Center for Hearing and Communication Research, Clintec, Karolinska University Hospital, Stockholm, Sweden
| | | |
Collapse
|
28
|
Ahn JH, Lim HW, Hong HR. The clinical application and efficacy of sodium hyaluronate-carboxymethylcellulose during tympanomastoid surgery. Laryngoscope 2012; 122:912-5. [DOI: 10.1002/lary.23213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 12/13/2011] [Accepted: 12/29/2011] [Indexed: 11/12/2022]
|
29
|
Ahn SM, Kim SS. Clinical Application of Polyether Ester Urethane in Endonasal Dacryocystorhinostomy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2012. [DOI: 10.3341/jkos.2012.53.6.743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Seong Min Ahn
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| | - Sang Soo Kim
- Department of Ophthalmology, Maryknoll Medical Center, Busan, Korea
| |
Collapse
|
30
|
Teh BM, Shen Y, Friedland PL, Atlas MD, Marano RJ. A review on the use of hyaluronic acid in tympanic membrane wound healing. Expert Opin Biol Ther 2011; 12:23-36. [DOI: 10.1517/14712598.2012.634792] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
31
|
Shen Y, Mei Teh B, Friedland PL, Eikelboom RH, Atlas MD. To pack or not to pack? A contemporary review of middle ear packing agents. Laryngoscope 2011; 121:1040-8. [DOI: 10.1002/lary.21470] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
32
|
Abstract
HYPOTHESIS To investigate whether OTO-104, a poloxamer-based hydrogel containing micronized dexamethasone for intratympanic delivery, can provide long-lasting inner ear exposure and be well tolerated. METHODS OTO-104 was administered intratympanically to guinea pigs and sheep, and its pharmacokinetic and toxicity profiles were examined. RESULTS After a single intratympanic injection of OTO-104 (from 0.6% to 20%, w/w), significant and prolonged exposure to dexamethasone in the inner ear was observed. Increasing the concentration of OTO-104 resulted in higher perilymph drug levels as well as a more prolonged duration of exposure. At the highest dose, therapeutic perilymph levels of dexamethasone could be sustained over 3 months in guinea pigs and more than 1 month in sheep. A toxicologic evaluation was conducted, including assessments of middle and inner ear function and physiology, as well as appraisal of local and systemic toxicity. A small and transient shift in hearing threshold was observed, most probably conductive in nature. No significant histologic changes in middle or inner ear tissues were noted. Although macroscopically mild erythema/inflammation was documented in a subset of guinea pigs treated with 20% OTO-104, the nature and the severity of these changes were not different between the poloxamer vehicle, saline, and 20% OTO-104 groups. No evidence of acute dermal toxicity, delayed hypersensitivity, or systemic adverse effects was found. CONCLUSION OTO-104 is a novel proprietary therapeutic delivery system that can achieve prolonged, sustained release of dexamethasone within the inner ear fluids. The administration of this clinical candidate formulation via intratympanic injection is expected to be well tolerated both locally and systemically.
Collapse
|
33
|
Huang G, Chen X, Jiang H. Effects of NasoPore Packing in the Middle Ear Cavity of the Guinea Pig. Otolaryngol Head Neck Surg 2011; 145:131-6. [PMID: 21493303 DOI: 10.1177/0194599811400834] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective. To evaluate the effects of NasoPore after packing of the middle ear in guinea pigs. Study Design. A randomized, prospective, controlled animal study. Setting. University laboratory. Subjects and Methods. Forty-one guinea pigs were divided into 3 groups. In group 1 (n = 12), the middle ears of animals were unilaterally implanted with NasoPore, leaving the contralateral middle ears packed with absorbable gelatin sponge soaked in a solution containing kanamycin and furosemide as an ototoxicity-positive control; group 2 (n = 17) underwent the same experimental protocol as group 1, except the gelatin sponge was unsoaked; in group 3 (n = 12), NasoPore was inserted unilaterally and no packing material was placed into the contralateral ear. Auditory brainstem responses (ABRs) were performed preoperatively and 3 months after the procedure. The surface preparation and scanning electron microscopy (SEM) were assessed 3 months postoperatively, whereas pathology of middle ear was analyzed in 5 samples of group 2. Results. ABR thresholds of the contralateral ear significantly increased in group 1 and were slightly shifted in group 2 compared with the NasoPore-packed and nonpacked ears 3 months postoperatively. The NasoPore-packed middle ears were found to have less fibrosis and inflammation and less thickened bone and tympanic membranes than Gelfoam-packed ears. Surface preparations and SEM showed no ototoxicity in the inner ear of NasoPore-packed ears. Conclusion. NasoPore appears to be effective for use in otosurgery. It caused less fibrosis in the middle ear than conventional packing agents and no ototoxicity to the inner ear.
Collapse
Affiliation(s)
- Guiliang Huang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xihui Chen
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongyan Jiang
- Otorhinolaryngology Hospital, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
| |
Collapse
|