Evaluation of Esterified Hyaluronic Acid as Middle Ear–Packing Material

Li, Geming; Feghali, Joseph G.; Dinces, Elizabeth; McElveen, John T.; Water, Thomas R. Van De

doi:10.1001/archotol.127.5.534

Cited by 38 publications

(39 citation statements)

References 7 publications

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“…HA is a non-ototoxic material. 29 Sensorineural hearing loss reported in patients who had undergone tympanoplasty procedures has not been noticed in any study on fat graft myringoplasty including our series. 5,8,14,[30][31][32] HAFGM does not involve manipulation of middle ear structures and, compared with traditional myringoplasty, carries a low risk of iatrogenic otologic trauma.…”

mentioning

confidence: 50%

Hyaluronic acid fat graft myringoplasty: A minimally invasive technique

Saliba¹,

Woods²

2011

The Laryngoscope

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mentioning

confidence: 50%

Hyaluronic acid fat graft myringoplasty: A minimally invasive technique

Saliba¹,

Woods²

2011

The Laryngoscope

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“…Gelatin polymers are widely used as absorbable hemostats in humans. Modified HA-based hydrogels containing low percentages of gelatin have been shown to be nontoxic to the guinea pig middle ear, to be completely biodegradable and to combine the absorbable hemostat properties of collagen with the antiadhesive and wound-healing properties of HA [Li et al, 2001;Öz-türk et al, 2006;Jang et al, 2008;Chang et al, 2009]. Modified HA-based hydrogels (including MeroGel and Sepragel) are commercially available for use in human surgery and have been used in the human middle ear without report of adverse events or signs of ototoxicity [Angeli, 2006;Caylan and Bektas, 2007;Saunders JE, unpubl.].…”

Section: Discussionmentioning

confidence: 99%

“…The viscous properties of HA, its safety profile and its presence in the middle ear for an extended period of time support its function as a suitable middle ear packing agent and a potential vehicle for drug delivery to the inner ear [Bagger-Sjöbäck et al, 1993;Krupala et al, 1998;Li et al, 2001;Jang et al, 2008]. However, the efficiency of HA as a carrier agent for IT delivery appears to be dependent on the specific drug being delivered and on the gel composition [Kelly et al, 1999;Chandrasekhar et al, 2000;Sheppard et al, 2004;Endo et al, 2005;Tsuyoshi et al, 2005;Yildirim et al, 2005;Coleman et al, 2007;James et al, 2008;Saber et al, 2009].…”

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Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Borden¹,

Saunders

Berryhill

et al. 2010

Audiol Neurotol

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Background: The use of intratympanic (IT) steroids for the treatment of inner ear disorders is promising, but the clinical challenges of prolonged middle ear drug application have proven burdensome, and a sustainable delivery system is yet to be developed. Method: In this study, a guinea pig model was used to determine if dexamethasone in combination with a hyaluronic-acid (HA)-based hydrogel is an efficient, stable and sustainable dexamethasone delivery system to the inner ear. For each animal, right and left middle ear bullae were randomly selected to be filled with dexamethasone alone or dexamethasone-HA (Dex-HA) gel. Perilymph samples were collected at different time points and dexamethasone levels were determined using an ELISA. Results: Dexamethasone was measurable in the perilymph samples up to 72 h after treatment. At 24 h after treatment, the perilymph dexamethasone concentrations were significantly higher (p = 0.01) in the ears treated with Dex-HA gel than in those treated with dexamethasone alone. While the perilymph dexamethasone concentration had decreased at 48 h after treatment with Dex-HA gel, the levels were still higher than those observed at 24 h in ears treated with dexamethasone alone. A high variability in dexamethasone concentration was observed between the samples, and the variability between matched ears receiving different treatments was remarkably lower than the variability within each treatment group, suggesting that individual parameters might play a major role in perilymph dexamethasone concentration. There was no statistically significant correlation between dexamethasone concentration and sex, weight or laterality. Conclusions: Our results show that the Dex-HA gel used in this study provides an effective and sustained dexamethasone release mechanism that might be utilized to treat conditions such as sudden sensorineural hearing loss. This could potentially reduce the morbidity and costs associated with IT treatment.

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“…[29][30][31] Merogel (Medtronic Xomed, Jacksonville, FL, USA) is an esterified derivative of hyaluronan that appears to have a longer duration than hyaluronan and can be easily used in a non-woven sponge preparation. Merogel has been used as an antiadhesive packing agent with good effect to stimulate mucosal epithelial healing in functional endoscopic sinus surgery (FESS), [29][30][31] middle ear surgery, 32,33 and tympanic membrane perforation repair surgery. 34 However, a number of studies have disputed the role of Merogel in mucosal epithelium recovery.…”

Section: Introductionmentioning

confidence: 99%

Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis

Cannon

Yan

et al. 2011

Eye

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Purpose To investigate the effects of Merogel coverage on ostial patency in endonasal endoscopic dacryocystorhinostomy (EES-DCR) for primary chronic dacryocystitis (PCD). Methods In all, 260 patients with unilateral PCD were randomized into two groups: the Merogel group and the control group. All patients underwent EES-DCR. The Merogel group received Merogel covering the wound 1-2 mm around the ostium and the control group received no treatment. Patients were followed up for 9 months. The mucosal epithelialization of the wound, the proliferation of fibrosis tissue, and the success rate of ostial patency were compared. Results Our study included 112 patients in the Merogel group and 115 patients in the control group. At the 2-week review, intact mucosal epithelium lined the ostia in 96 Merogel patients compared with 80 control patients (ITT analysis: v 2 ¼ 4.502, P ¼ 0.034). At the 9-month review, scars were present in 18 patients in the Merogel group compared with 39 patients in the control group (ITT analysis: v 2 ¼ 9.909, P ¼ 0.002, ITT analysis). No differences were observed in the granulation formation between the two groups. The success rate of ostial patency reached 94.6% (106/112) in the Merogel group compared with 80% (92/115) in the control group (ITT analysis: v 2 ¼ 4.151, P ¼ 0.042). Conclusion Merogel coverage may enhance the success rate of EES-DCR for PCD by promoting mucosal epithelial healing and preventing excessive scarring.

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Evaluation of Esterified Hyaluronic Acid as Middle Ear–Packing Material

Cited by 38 publications

References 7 publications

Hyaluronic acid fat graft myringoplasty: A minimally invasive technique

Hyaluronic acid fat graft myringoplasty: A minimally invasive technique

Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Effects of Merogel coverage on wound healing and ostial patency in endonasal endoscopic dacryocystorhinostomy for primary chronic dacryocystitis

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