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Lou Z, Li C, Yu D, Wang J, Chen Z, Yin S. Comparison of healing of acute total tympanic membrane perforation between rats with and without excision of the mallear handle. Laryngoscope Investig Otolaryngol 2023; 8:1648-1656. [PMID: 38130269 PMCID: PMC10731538 DOI: 10.1002/lio2.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 09/15/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objective We compared the histological changes and hearing restoration during the healing of acute total tympanic membrane (TM) perforations between Sprague-Dawley (SD) rats with and without excision of the mallear handle. Materials and methods Bilateral, acute, and total TM perforations were created in 36 male SD rats. The mallear handle was preserved in the left ear (handle-preserved ear [HPE]) and excised from the right ear (handle-excised ear [HEE]). Endoscopical examination, auditory brainstem response (ABR) thresholds, histopathological, and scanning electron microscope (SEM) analysis were performed. Results Endoscopic photographs showed that all perforations in the 18 SD rats were closed. The mean closure times were 6.83 ± 0.85 and 8.50 ± 0.71 days in the HPE and HEE groups, respectively (p < .001). SEM images showed radial arrangement of fiber bundles in a single direction in HPEs, although normal arrangement was not achieved. In contrast, HEEs showed disorganized arrangement. At 1 month after perforation closure, the ABR thresholds at high frequencies were significantly higher in the HEE group than in the HPE group (p = .029 and p = .017 for 16 and 32 kHz, respectively). Additionally, the changes in ABR threshold were significantly different at high frequencies (p = .011 and p = .017 for 16 and 32 kHz, respectively) before and 1 month after perforation closure between the HPE and HEE groups, although the differences were not statistically significant at the remaining frequencies. Conclusion Although the malleus handle may not affect the closure of total perforation in SD rats, it contributes to accelerate the perforation closure by possible guide the migration of proliferative epithelial cell on the upper halves of the annulus. Additionally, resection of the malleus handle impairs high frequency hearing recovery following spontaneous closure of the TM.
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Affiliation(s)
- Zihan Lou
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Chunyan Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Dongzhen Yu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Jingjing Wang
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Zhengnong Chen
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
| | - Shankai Yin
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Department of Otolaryngology‐Head and Neck Surgery & Center of Sleep MedicineShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
- Otolaryngological Institute of Shanghai Jiao Tong UniversityShanghaiChina
- Shanghai Key Lab Sleep Disordered BreathingShanghaiChina
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Scaria SM, Frumm SM, Vikram EP, Easow SA, Sheth AH, Shamir ER, Yu SK, Tward AD. Epimorphic regeneration in the mammalian tympanic membrane. NPJ Regen Med 2023; 8:58. [PMID: 37852984 PMCID: PMC10584978 DOI: 10.1038/s41536-023-00332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/29/2023] [Indexed: 10/20/2023] Open
Abstract
Adult mammals are generally believed to have limited ability to regenerate complex tissues and instead, repair wounds by forming scars. In humans and across mammalian species, the tympanic membrane (TM) rapidly repairs perforations without intervention. Using mouse models, we demonstrate that the TM repairs itself through a process that bears many hallmarks of epimorphic regeneration rather than typical wound healing. Following injury, the TM forms a wound epidermis characterized by EGFR ligand expression and signaling. After the expansion of the wound epidermis that emerges from known stem cell regions of the TM, a multi-lineage blastema-like cellular mass is recruited. After two weeks, the tissue architecture of the TM is largely restored, but with disorganized collagen. In the months that follow, the organized and patterned collagen framework of the TM is restored resulting in scar-free repair. Finally, we demonstrate that deletion of Egfr in the epidermis results in failure to expand the wound epidermis, recruit the blastema-like cells, and regenerate normal TM structure. This work establishes the TM as a model of mammalian complex tissue regeneration.
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Affiliation(s)
- Sonia M Scaria
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Stacey M Frumm
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Ellee P Vikram
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Sarah A Easow
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Amar H Sheth
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Eliah R Shamir
- Department of Pathology, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Shengyang Kevin Yu
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA
| | - Aaron D Tward
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, 94143, USA.
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Zong H, Lou Z. Healing large Traumatic Tympanic Membrane Perforations Using Vaseline Gauze and Gelfoam Patching Alone. EAR, NOSE & THROAT JOURNAL 2023:1455613221150571. [PMID: 36625009 DOI: 10.1177/01455613221150571] [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: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of vaseline gauze (VG) patching on the treatment of large traumatic perforation of tympanic membrane (TM). MATERIAL AND METHODS 90 patients with traumatic perforation larger than 25% of the TM were randomly allocated into the control group of observation only, VG group, and Gelfoam patch alone group. The closure rate and closure time among the 3 groups were compared at 3 months. RESULTS In total, 82 large traumatic perforations were analyzed in this study. The closure rates in the control, VG, and gelfoam patch groups were 84.6%, 100.0%, and 89.3%, respectively (P = 0.637). Post-hoc multiple comparisons showed that the difference between the control and VG groups was significant (P = 0.047), but the difference wasn't significant between gelfoam alone and control groups (P = 0.699) or VG groups (P = 0.236). The mean closure times were 5.41 ± 1.47, 2.14 ± 0.93, and 3.00 ± 0.62 weeks for the control, VG, and gelfoam patch groups, respectively (P < 0.001). Post-hoc multiple comparisons showed that the difference was significant between the control and VG groups (P < 0.001) or gelfoam alone group (P < 0.001) or VG and gelfoam groups (P < 0.05). CONCLUSIONS VG improved the closure rate and shortened the closure time compared with observation only, which could be an effective patch material for repairing traumatic lager perforations in the outpatient setting, which is readily available and convenient.
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Affiliation(s)
- Huiqin Zong
- Department of Otorhinolaryngology, Wenzhou medical university affiliated Yiwu Hospital, Yiwu city, China
| | - Zhengcai Lou
- Department of Otorhinolaryngology, Wenzhou medical university affiliated Yiwu Hospital, Yiwu city, China
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Li Y, Ding Y, Li D, Xin Y, Wei R, Liu Y. With and without exogenous biological scaffolds for repairing traumatic perforations of tympanic membrane: Randomized clinical trials. Am J Otolaryngol 2023; 44:103650. [DOI: 10.1016/j.amjoto.2022.103650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/06/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
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Pothupitiya JU, Zheng C, Saltzman WM. Synthetic biodegradable polyesters for implantable controlled-release devices. Expert Opin Drug Deliv 2022; 19:1351-1364. [PMID: 36197839 DOI: 10.1080/17425247.2022.2131768] [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: 11/04/2022]
Abstract
INTRODUCTION : Implantable devices can be designed to release drugs to localized regions of tissue at sustained and reliable rates. Advances in polymer engineering have led to the design and development of drug-loaded implants with predictable, desirable release profiles. Biodegradable polyesters exhibit chemical, physical, and biological properties suitable for developing implants for pain management, cancer therapy, contraception, antiviral therapy, and other applications. AREAS COVERED : This article reviews the use of biodegradable polyesters for drug-loaded implants by discussing the properties of commonly used polymers, techniques for implant formulation and manufacturing, mechanisms of drug release, and clinical applications of implants as drug delivery devices. EXPERT OPINION : Drug delivery implants are unique systems for safe and sustained drug release, providing high bioavailability and low toxicity. Depending on the implant design and tissue site of deployment, implants can offer either localized or systemic drug release. Due to the long history of use of degradable polyesters in medical devices, polyester-based implants represent an important class of controlled release technologies. Further, polyester-based implants are the largest category of drug delivery implants to reach the point of testing in humans or approval for human use.
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Affiliation(s)
- Jinal U Pothupitiya
- Department of Biomedical Engineering, Yale University; New Haven, CT 06511, USA
| | - Christy Zheng
- Department of Biomedical Engineering, Yale University; New Haven, CT 06511, USA
| | - W Mark Saltzman
- Department of Biomedical Engineering, Yale University; New Haven, CT 06511, USA
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Liu Y, Wu C, Chen T, Shen Q, Xiong Y, Chen Z, Li C. Evaluation of acoustic changes in and the healing outcomes of rat eardrums with pars tensa and pars flaccida perforations. Laryngoscope Investig Otolaryngol 2022; 7:816-824. [PMID: 35734049 PMCID: PMC9194967 DOI: 10.1002/lio2.797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/11/2022] [Accepted: 04/09/2022] [Indexed: 11/27/2022] Open
Abstract
Objectives To systematically explore the differences in acoustic changes and healing outcomes of tympanic membranes (TMs) with pars flaccida perforation (PFP) and pars tensa perforation (PTP). Methods We created PFPs and PTPs of various sizes in Sprague–Dawley rats, and evaluated TM umbo velocity and hearing function using laser Doppler vibrometry and auditory brainstem response (ABR) measurement before and immediately after perforation. Two weeks later, hearing was reevaluated and TMs were investigated by immunohistochemical staining. Results Small PFPs and PTPs did not significantly affect umbo velocity and hearing function. Large PFPs increased umbo velocity loss at low frequency (1.5 kHz) and elevated ABR thresholds within 1–2 kHz. Large PTP caused significant velocity loss at low frequencies from 1.5 to 3.5 kHz and threshold elevations at full frequencies (1–2 kHz). Two weeks after the perforation, the hearing function of rats with healed PFPs recovered completely. However, high‐frequency hearing loss (16–32 kHz) persisted in rats with healed PTPs. Morphological staining revealed that no increase in the thickness and obvious increase in collagen I level of regenerated par flaccida; regenerated pars tensa exhibited obvious increase in thickness and increased collagen I, while the collagen II regeneration was limited with discontinuous and disordered structure in regenerated pars tensa. Conclusion The hearing loss caused by large PFP limits at low frequencies while large PTP can lead to hearing loss at wide range frequencies. PFP and PTP have different functional outcomes after spontaneous healing, which is determined by the discrepant structure reconstruction and collagen regeneration.
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Affiliation(s)
- Yaoqian Liu
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Cuiping Wu
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Tingting Chen
- Department of Hearing and Language Rehabilitation Zhejiang Chinese Medicine University Hangzhou China
| | - Qiyue Shen
- Department of Hearing and Language Rehabilitation Shanghai University of Traditional Chinese Medicine Shanghai China
| | - Yuanping Xiong
- Department of Otolaryngology Head and Neck Surgery First Affiliated Hospital of Nanchang University Nanchang China
| | - Zhengnong Chen
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
- Department of Otolaryngology‐Head and Neck Surgery Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
| | - Chunyan Li
- Otolaryngology Research Institute Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
- Department of Otolaryngology‐Head and Neck Surgery Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai China
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Mozaffari M, Jiang D, Tucker AS. Developmental aspects of the tympanic membrane: Shedding light on function and disease. Genesis 2019; 58:e23348. [PMID: 31763764 PMCID: PMC7154630 DOI: 10.1002/dvg.23348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/19/2022]
Abstract
The ear drum, or tympanic membrane (TM), is a key component in the intricate relay that transmits air-borne sound to our fluid-filled inner ear. Despite early belief that the mammalian ear drum evolved as a transformation of a reptilian drum, newer fossil data suggests a parallel and independent evolution of this structure in mammals. The term "drum" belies what is in fact a complex three-dimensional structure formed from multiple embryonic cell lineages. Intriguingly, disease affects the ear drum differently in its different parts, with the superior and posterior parts being much more frequently affected. This suggests a key role for the developmental details of TM formation in its final form and function, both in homeostasis and regeneration. Here we review recent studies in rodent models and humans that are beginning to address large knowledge gaps in TM cell dynamics from a developmental biologist's point of view. We outline the biological and clinical uncertainties that remain, with a view to guiding the indispensable contribution that developmental biology will be able to make to better understanding the TM.
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Affiliation(s)
- Mona Mozaffari
- Centre for Craniofacial and Regenerative Biology, King's College London, Guy's Hospital, London, UK
| | - Dan Jiang
- Centre for Craniofacial and Regenerative Biology, King's College London, Guy's Hospital, London, UK.,ENT Department, Guy's Hospital, London, UK
| | - Abigail S Tucker
- Centre for Craniofacial and Regenerative Biology, King's College London, Guy's Hospital, London, UK
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