To pack or not to pack? A contemporary review of middle ear packing agents

Shen, Yi; Teh, Bing Mei; Friedland, Peter; Eikelboom, Robert H.; Atlas, Marcus D.

doi:10.1002/lary.21470

Cited by 46 publications

(62 citation statements)

References 103 publications

(173 reference statements)

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“…Gelfilm was suggested [Holzer, 1973;Falbe-Hansen and Tos, 1975] instead of Gelfoam because it causes less adhesion owing to its nonporous structure [McGhee and Dornhoffer, 1999], but it has the disadvantage of application because of its hardness [Shen et al, 2011]. Hyaluronic acid was proved to be safe [Laurent et al, 1988;Bagger-Sjoback et al, 1993;Angeli et al, 2007;Jang et al, 2008b] in the ME, and various modified forms were tried to improve its stability such as its esterified form, Merogel [Martini et al, 2000].…”

Section: Discussionmentioning

confidence: 99%

“…It should provide support to TM grafts and the ossicular chain, promote ME wound healing and hemostasis, and prevent adhesions and fibrosis [Shen et al, 2011].…”

Section: Discussionmentioning

confidence: 99%

“…It should provide support to TM grafts and the ossicular chain, prevent adhesion formation, promote ME wound healing and hemostasis. To date there is no such material [Shen et al, 2011]. The packing material most commonly used in otologic surgery is Gelfoam (Pharmacia and Upjohn Company, Mich., USA), an absorbable, gelatinbased sponge material.…”

Section: Introductionmentioning

confidence: 99%

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Safety and Efficacy of Chitosan-Dextran Hydrogel in the Middle Ear in an Animal Model

Ünsaler

Başaran²,

Sarı³

et al. 2016

Audiol Neurotol

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Objectives: To investigate the efficacy of chitosan-dextran hydrogel (CDH) in preventing postoperative adhesions between the tympanic membrane (TM) and intratympanic structures, and to evaluate its ototoxicity in an animal study. Methods: In the first step, ototoxicity was evaluated with 7 male albino guinea pigs (GPs) via auditory brainstem responses (ABR) before and 4 weeks after unilateral intratympanic injection of CDH and saline solution contralaterally. In the second step, 12 GPs underwent bilateral ear surgery. The middle ear (ME) mucosa was abraded, and the cavity was filled with CDH on one side and packed with Gelfoam on the contralateral side. A control group of 6 GPs underwent the same procedure except that no material was applied in the ME. The animals were euthanized at the end of the 7th week, and otomicroscopic findings were noted and the temporal bones harvested for the histologic examination. The findings were scored and compared. Results: There was no statistically significant difference between the pre- and postoperative ABR thresholds. In the otomicroscopic findings, the most prominent difference between the two groups was the presence of retraction of the TM in the Gelfoam group. The histopathologic findings revealed a higher degree of inflammation in the Gelfoam group compared with the CDH group. Conclusion: This study demonstrated that CDH has no ototoxic effects in GPs. Its use as an ME packing material revealed significantly less TM retraction and inflammatory reaction compared with Gelfoam.

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Section: Discussionmentioning

confidence: 99%

“…It should provide support to TM grafts and the ossicular chain, promote ME wound healing and hemostasis, and prevent adhesions and fibrosis [Shen et al, 2011].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Safety and Efficacy of Chitosan-Dextran Hydrogel in the Middle Ear in an Animal Model

Ünsaler

Başaran²,

Sarı³

et al. 2016

Audiol Neurotol

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“…But gelfoam may show detrimental effects such as adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. 3 Many surgeons advocate the use of gelfoam either in the dry form or following application of ointment or drops in the middle ear in underlay tympanoplasty to provide a bed for the graft which supports the graft and prevents its medialization. The use of ointment or drops prevents further absorption of blood or tissue fluid into the gelfoam and prevents further lateralization of the graft.…”

Section: Introductionmentioning

confidence: 99%

Comparative study of type 1 tympanoplasty with and without gelfoam in the middle ear

Malick

Gadag

Vidyashree

et al. 2017

Int J Otorhinolaryngol Head Neck Surg

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Background: Chronic suppurative otitis media is a widespread disease with a significant cause of morbidity with a greater burden in the poor communities of the developing countries for which tympanoplasty is frequently undertaken. Gelfoam may show detrimental effects such as adhesions and fibrosis and improper packing may physically alter the structure of the tympanic membrane leading to failure of tympanoplasty. The graft can be placed without any middle ear supporting agent wherein the graft is held in position by the surface tension between the novel graft placed and the remnant tympanic membrane. This provides the added advantage of facilitating middle ear ventilation through the Eustachian tube. The objectives of the study were to assess the graft uptake and hearing improvement following type 1 tympanoplasty with gelfoam in the middle ear and without gelfoam in the middle ear and to compare and assess results for complicationsMethods: This was a randomised control trial done for a period of one year conducted in the department of otorhinolaryngology and head and neck surgery, Karnataka Institute of Medical Sciences, Hubballi which is a tertiary referral hospital. 30 patients underwent type 1 tympanoplasty without gelfoam in the middle ear and 31 patients underwent type 1 tympanoplasty with gelfoam in the middle ear. Post-operative follow up was done to look for graft uptake, hearing assessment by pure tone audiometry and impedance audiometry was done 90 days post-operatively. Results: Graft uptake was 80% in type 1 tympanoplasty without gelfoam in the middle ear and 80.6% with gelfoam in the middle ear. Both types of surgeries had significant hearing improvement, and complications like retraction and residual perforation were also comparable. Ad type of impedance curve is most common post operatively.Conclusions: Graft uptake is equally good in cases with gelfoam and without gelfoam. Hearing gain is comparable in both groups of patients. No significant complications occurred in our study. ‘Ad’ is the most common type of impedance curve after surgery. Long term follow up is important in these patients.

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“…51 Gelfoam is also used for traumatic perforations 52 and is known to be nontoxic, biocompatible, easily handled, and provides reasonable hemostasis. Silk fibroin, typically obtained from the silkworm species Bombyx mori after the removal of antigenic sericin, has been shown to support the growth and spread of different cell types, including keratinocytes derived from human TM.…”

mentioning

confidence: 99%

Tissue Engineering of the Tympanic Membrane

Teh

Marano

Shen

et al. 2013

Tissue Engineering Part B: Reviews

Self Cite

120

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Tympanic membrane (TM) perforations are common, with current treatments for chronic perforations involving surgery, using various graft materials, from autologous cartilage or fascia through to paper patch. Recent research developments in this field have begun applying the principles of tissue engineering, with appropriate scaffolds, cells, and bioactive molecules (BMs). This has revolutionized the therapeutic approach due to the availability of a wide range of materials with appropriate compatibility and mechanical properties to regenerate the membrane acoustics and may also represent a paradigm shift in the management of TM perforations in an outpatient setting without surgery. However, many factors need to be considered in the fabrication of a bioengineered TM. This review discusses the issues associated with current treatment and examines TM wound healing relevant to the construction of a bioengineered TM. It also describes the tissue-engineering approach to TM regeneration by summarizing currently used scaffolds, BMs, and cells in TM wound healing. Finally, it considers the design of scaffolds, delivery of BMs, and cell engraftment toward potential clinical application.

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To pack or not to pack? A contemporary review of middle ear packing agents

Cited by 46 publications

References 103 publications

Safety and Efficacy of Chitosan-Dextran Hydrogel in the Middle Ear in an Animal Model

Safety and Efficacy of Chitosan-Dextran Hydrogel in the Middle Ear in an Animal Model

Comparative study of type 1 tympanoplasty with and without gelfoam in the middle ear

Tissue Engineering of the Tympanic Membrane

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