Repair of Chronic Tympanic Membrane Perforations Using Applications of Hyaluronan or Rice Paper Prostheses

Abstract

A controlled randomized study was performed in 60 patients with 64 chronic, dry tympanic membrane (TM) perforations. The perforations were randomly allocated to either resection of the perforation rim and instillation of 1 % hyaluronan (Healon®; HYA) in the perforation gap once daily for 7 days (33 ears) or resection of the perforation margin and application of a sterile rice paper prosthesis (31 ears). The treatment effect was documented by TM photography and morphometric measurements of the perforation area. The hearing was assessed with pure-tone and high-frequency audiometry. After 2 months, 5 of the HYA-treated perforations (15 %) and 4 of the rice-paper-treated TMs (13%) were healed. After 1 year, 18 perforations (9 in each treatment group) were healed. In neither group were there any persistent adverse effects on hearing. It is noteworthy that 28% (18/64) of the chronic, long-standing TM perforations could be repaired by these technically simple and time-saving methods. Both procedures should be considered as easy first-choice alternatives to myringoplasty in selected cases.

Hyaluronan and cell locomotion

“…Magnification 570 ×. motion [9] and since HA is considered to play an important role in wounding responses [12,51].…”

“…HA was rapidly destroyed so that by day 6 after injury, levels were declining. Indeed, clinically, the addition of HA to wounded tissues, for instance the tympanic membrane, speeded the closure of the wound and interestingly reduced scarring, presumably due to an inhibition of collagen synthesis [12]. Finally, levels of HA have been noted to be regulated during tumorigenesis [13] most notably during tumor invasion [1,3].…”

Hyaluronic acid fat graft myringoplasty: A minimally invasive technique

“…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. Gelfoam inserted in the middle ear to support the fat graft does not appear to affect the result of conductive hearing loss at the fourth postoperative month.…”

Inlay Butterfly Cartilage Tympanoplasty in Children

“…Several new techniques have been proposed to simplify the surgical procedure. Most of them consist of resecting the perforation margins and then inserting a material such as fat (13), cartilage (14), or a synthetic device (15) through the perforation, or placing under and/or over the perforation one or two layers of a substance that stimulates and guides the perforation closure, such as hyaluronan (16) or basic fibroblast growth factor (17). As compared with classic techniques such as UFTT, these techniques have several advantages: they are easy and time-saving; they do not require any tympanomeatal flap; they can be performed in adults under local anesthesia and in children under general anesthesia without any endotracheal intubation as a day-stay procedure (13,14); and postoperative ear-packing is not necessary, which is particularly convenient in children.…”