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Mankekar G, Entezami P. Acquired Stenosis of the External Ear Canal. Otolaryngol Clin North Am 2023; 56:919-931. [PMID: 37553271 DOI: 10.1016/j.otc.2023.06.012] [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] [Indexed: 08/10/2023]
Abstract
Acquired stenosis of the external ear canal (ASEEC) is a relatively uncommon condition. Stenosis or narrowing of the external ear canal (EEC) occurs lateral to the tympanic membrane resulting in a skin lined blind canal. Recurrent otorrhea, and conductive hearing loss are typical clinical features. Although ASEEC can be due to different etiologies, a common pathogenesis, namely an inflammatory cascade, has been implicated. Clinical evaluation, audiogram, and Computed tomography (CT scan) form the mainstay of diagnosis. Surgery is the primary modality for treatment. Restenosis is the most common postsurgical complication.
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Affiliation(s)
- Gauri Mankekar
- Department of Otolaryngology-Head Neck Surgery, Louisiana State University Health, Shreveport, LA, USA.
| | - Payam Entezami
- Department of Otolaryngology-Head Neck Surgery, Louisiana State University Health, Shreveport, LA, USA
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Matin-Mann F, Gao Z, Schwieger J, Ulbricht M, Domsta V, Senekowitsch S, Weitschies W, Seidlitz A, Doll K, Stiesch M, Lenarz T, Scheper V. Individualized, Additively Manufactured Drug-Releasing External Ear Canal Implant for Prevention of Postoperative Restenosis: Development, In Vitro Testing, and Proof of Concept in an Individual Curative Trial. Pharmaceutics 2022; 14:pharmaceutics14061242. [PMID: 35745813 PMCID: PMC9228097 DOI: 10.3390/pharmaceutics14061242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/16/2022] Open
Abstract
Postoperative restenosis in patients with external ear canal (EEC) atresia or stenosis is a common complication following canaloplasty. Our aim in this study was to explore the feasibility of using a three dimensionally (3D)-printed, patient-individualized, drug ((dexamethasone (DEX)), and ciprofloxacin (cipro))-releasing external ear canal implant (EECI) as a postoperative stent after canaloplasty. We designed and pre-clinically tested this novel implant for drug release (by high-performance liquid chromatography), biocompatibility (by the MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay), bio-efficacy (by the TNF-α (tumor necrosis factor-alpha)-reduction test (DEX) and inhibition zone test (for cipro)), and microbial contamination (formation of turbidity or sediments in culture medium). The EECI was implanted for the first time to one patient with a history of congenital EEC atresia and state after three canaloplasties due to EEC restenosis. The preclinical tests revealed no cytotoxic effect of the used materials; an antibacterial effect was verified against the bacteria Staphylococcus aureus and Pseudomonas aeruginosa, and the tested UV-irradiated EECI showed no microbiological contamination. Based on the test results, the combination of silicone with 1% DEX and 0.3% cipro was chosen to treat the patient. The EECI was implantable into the EEC; the postoperative follow-up visits revealed no otogenic symptoms or infections and the EECI was explanted three months postoperatively. Even at 12 months postoperatively, the EEC showed good epithelialization and patency. Here, we report the first ever clinical application of an individualized, drug-releasing, mechanically flexible implant and suggest that our novel EECI represents a safe and effective method for postoperatively stenting the reconstructed EEC.
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Affiliation(s)
- Farnaz Matin-Mann
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Correspondence: ; Tel.: +49-511-532-6565; Fax: +49-511-532-8001
| | - Ziwen Gao
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
| | - Jana Schwieger
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
| | - Martin Ulbricht
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Vanessa Domsta
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Stefan Senekowitsch
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Werner Weitschies
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
| | - Anne Seidlitz
- Center of Drug Absorption and Transport, Department of Biopharmacy and Pharmaceutical Technology, Institute of Pharmacy, University of Greifswald, 17489 Greifswald, Germany; (M.U.); (V.D.); (S.S.); (W.W.); (A.S.)
- Institute of Pharmaceutics and Biopharmaceutics, University of Duesseldorf, 40225 Dusseldorf, Germany
| | - Katharina Doll
- Clinic for Dental Prosthetics and Biomedical Materials Science, Hanover Medical School, 30625 Hannover, Germany; (K.D.); (M.S.)
| | - Meike Stiesch
- Clinic for Dental Prosthetics and Biomedical Materials Science, Hanover Medical School, 30625 Hannover, Germany; (K.D.); (M.S.)
| | - Thomas Lenarz
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
| | - Verena Scheper
- Department of Otorhinolaryngology, Head and Neck Surgery, Lower Saxony Center for Biomedical Engineering, Implant Research and Development (NIFE), Hannover Medical School, Stadtfelddamm 34, 30625 Hannover, Germany; (Z.G.); (J.S.); (T.L.); (V.S.)
- Cluster of Excellence”Hearing4all” EXC 1077/1, 30625 Hannover, Germany
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