Fibrin-Glue-Reinforced Paper Patch Myringoplasty of Large Persistent Tympanic Membrane Perforations in the Guinea Pig

Abstract

Investigators have attempted to simplify and improve myringoplasty. However, techniques have not been applied to large, chronic human tympanic membrane perforations. Fibrin glue has been shown to improve wound strength but has not been significantly utilized in myringoplasty. To evaluate the effectiveness of paper patch myringoplasty reinforced with fibrin glue, 15 guinea pigs underwent repeated myringectomy to form persistent ( > 50%) perforations. The right ears were repaired with a paper patch and fibrin glue (treatment group), and the left ears with a paper patch alone (control group). Of 16 surviving ears (9 right and 7 left), only 1 a left ear, failed to heal. In the control group, histology revealed a larger fibrous layer approaching greater total eardrum thickness than in the treatment group. Neither group was significantly different from a normal, nonoperated tympanic membrane in terms of overall thickness. Fibrin glue failed to demonstrate histologic evidence of increased cellular proliferation and possibly hindered growth. High spontaneous healing rates in guinea pigs undermine myringoplasty modeling.

Crosslinked hydrogels for tympanic membrane repair

“…The acutely injured tympanic membrane will often heal spontaneously and may not reflect the problematic issues associated with a chronic perforation. DiLeo and Amedee 25 have described perforating the tympanic membrane of guinea pigs every 3 weeks until a persistent, Ͼ50% perforation is present. We used this technique in a small pilot study to create persistent perforations.…”

Ein verbessertes Tiermodell f�r chronische Trommelfellperforationen

“…Meerschweinchen und Chinchillas vor[1,6,26,31,32].Da die Trommelfellreparation bei diesen Tieren schnell und hartnäckig erfolgt, spricht man bei Persistenz des Defektes über 5-8 Wochen von chronischen Perforationen [1, 22, 31]. Wir haben im vorliegenden Versuch einen Zeitraum von 8 Wochen gewählt und die Ratte aufgrund einer dem Menschen ähnlichen Trommelfellstruktur [28] sowie aus Preisgründen bevorzugt.…”

“…Ursache der gehemmten Reparation ist wahrscheinlich eine reduzierte Bildung von Wachstumsfaktoren [17]. Da jedoch bei Versuchstieren nach repetitiven Narkosen mit relevanten Verlusten zu rechnen ist [6], haben wir in unserer Versuchsreihe eine Reduktion der Interventionen angestrebt. In Verbindung mit einer partiellen Hammergriffresektion haben wir mit einer 2-maligen lokalen Prednisolonbehandlung eine merkliche Heilungsverzögerung induziert.…”

Paper Patching for Chronic Tympanic Membrane Perforations

“…1 This technique is still practiced for acute and traumatic perforations 13 or after the removal of a ventilation tube, 14 although most of these perforations heal spontaneously. Animal studies with paper-patch myringoplasty for chronic longstanding perforations were performed by several investigators, 15,16 but only a few studies were performed on humans, with successful closure of the perforations in a minority of the cases and only for very small perforations. 17,18 The purpose of this study was to report the results of paper-patch myringoplasties, performed as an outpatient procedure, in patients with longstanding dry perforations of the TM.…”