The effect of platelet-rich fibrin membrane on the repair of perforated tympanic membrane: an experimental study

Conclusion: Platelet-rich fibrin (PRF) membrane could be used successfully in the repair of tympanic membrane perforation and wound healing.

Objectives: To evaluate the effect of platelet-rich fibrin membrane in the repair of perforated tympanic membrane.

Methods: After otoscopic examination, a 3-mm perforation was made in the posterior quadrant of both tympanic membranes of 50 adult male Sprague-Dawley rats. Venous blood was withdrawn from the rats, then centrifuged. PRF was obtained in membrane form. The membrane was placed on the right tympanic membrane perforation. The perforations on the left side were left to spontaneously heal and, thus, formed the control group. Daily examinations were made of 20 rats and the time to healing of the tympanic membrane was recorded. The remaining 30 rats were separated into five groups of six, and histopathological examination was made. Evaluation was made in respect of the presence of oedema in the lamina propria, neovascularization, fibroblastic reaction, and inflammatory cells.

Results: The healing time of the tympanic membrane perforation was determined as mean 10.3?±?2.18 days in the study group applied with PRF and 17?±?2.40 days in the control group. Higher values in respect of fibrosis and neovascularization were obtained in the study group.     

创伤性鼓膜穿孔的治疗及其研究进展

目的创伤性鼓膜穿孔是耳鼻咽喉科门急诊中常见的疾病之一。对于创伤性鼓膜穿孔的治疗有多种方法可供选择,但是目前国内外尚无统一的标准。创伤性鼓膜穿孔自然愈合机制比较复杂,影响其愈合及预后的因素较多,不合理的治疗会给患者带来不良的影响。本文介绍了创伤性鼓膜穿孔的自然愈合情况,以及汇总近年国内外关于创伤性鼓膜穿孔的治疗及研究进展,并予以综述,旨在为创伤性鼓膜穿孔的临床治疗方法的选择和研究提供参考。     

A new method for closing tympanic membrane perforations using basic fibroblast growth factor

OBJECTIVE: To present a new method for closing tympanic membrane perforations using basic fibroblast growth factor (bFGF) combined with an atelocollagen/silicone bilayer membrane as a patch material. STUDY DESIGN: Closure of tympanic membrane perforations was attempted using bFGF, which is thought to facilitate the growth of fibroblasts and collagen fibers at the margin of the perforation. METHODS: Under an operating microscope, the margin of the perforation was trimmed, and a piece of an atelocollagen/silicone bilayer membrane infiltrated with 0.2 mL Trafermin (0.1% solution) (bFGF group) or saline (control group) was then placed in the perforation with the silicon layer facing outward. Nine patients were treated with bFGF, and five were treated with saline. Data obtained from patient records included patient age, perforation size, and duration of treatment, with a focus on hearing improvement and complete tympanic membrane closure. RESULTS: The mean perforation size before treatment was 16.5% in the bFGF group and 9.6% in the control group. Closure of the tympanic membrane perforation was achieved in all cases in the bFGF group, whereas it was achieved in only two of five cases in the control group. With bFGF treatment, the tympanic membrane perforations closed completely within 3.7 weeks, and hearing improved by 13.3 dB in the bFGF group. CONCLUSION: The study demonstrated that bFGF combined with an atelocollagen/silicone bilayer membrane is effective for the conservative treatment of tympanic membrane perforation.     

Hearing loss in the 4-8 kHz range following tympanic membrane perforation from minor trauma

This study looked at the incidence of sensorineural hearing loss in the 4-8 kHz range in patients with unilateral tympanic membrane perforations from minor trauma who presented to the department in the past year. Eleven patients conformed to our inclusion criteria, one was lost to follow-up. Perforation was present in all patients in the pars tensa and no treatment was required in nine patients. The mean sensorineural hearing loss at 4,6 and 8 kHz was 28.2 dB on initial examination and 14.6 dB by Day 30. All 11 patients had normal hearing in the contra-lateral ear (mean 13.5 dB). In this group of patients with a tympanic membrane perforation from minor trauma the conductive hearing loss was accompanied by a significant (P= 0.001) but reversible high frequency sensorineural deafness.     

Spontaneous healing of various tympanic membrane perforations in the rat

Objectives—To investigate the spontaneous healing process of various types of perforation and the location of the epithelial generation center in the tympanic membrane of rats.

Material and methods—Various types of perforation were made in the ears of 50 rats and the healing process was observed using light and electron microscopy.

Results—Epithelia hyperplasia could not be seen at the edge of the perforations, but occurred in the annulus and handle of malleus regions during the early stage of healing. There was no correlation between the healing time and the size of the perforations. When one ear was perforated, no changes were observed in the intact ear on the other side. The epithelium did not migrate into the tympanic cavity in the posterior marginal perforations. All the perforations healed, although the manubria of the malleus were damaged.

Conclusions—The perforations healed by means of epithelial migration. The epithelial generation center was located near the annulus and the handle of the malleus, and therefore protection of these two regions is very important in middle ear surgery.     

外伤性鼓膜穿孔的法医学鉴定分析

目的 总结外伤性鼓膜穿孔的法医学鉴定规律。方法 回顾性分析308例316耳外伤性鼓膜穿孔法医学鉴定资料。结果 确诊外伤性鼓膜穿孔237耳，穿孔愈合50耳，穿孔合并感染6耳，排除穿孔11耳，8例（耳）排除与所受外伤的关系，3例（耳）无法认定外伤性鼓膜穿孔，1例（耳）诊为慢性化脓性中耳炎。结论外伤性鼓膜穿孔诊断要点为：（1）有耳部或头部受伤史；（2）伴耳痛、耳聋、外耳道少量出血；（3）形态符合外伤性穿孔特点：穿孔多位于紧张部．呈裂隙状、三角形、不规则形等。穿孔边缘锐利、外翻，附有血痂；（4）声导抗检查不能引出鼓室图，或伤耳呈B型曲线但外耳道容积明显大于健耳；（5）排除中耳炎所致穿孔。声导抗和耳内镜检查可以客观真实的反映鼓膜穿孔的形态特征．能为外伤性鼓膜穿孔的法医学鉴定提供客观依据。     

特殊类型鼓膜外伤性穿孔急性期外科干预的可行性分析

目的探索特殊类型鼓膜外伤性穿孔急性期外科干预的可行性。方法对本科2001年3月～2006年4月接诊的58例特殊类型鼓膜外伤性穿孔的临床资料及愈合因素进行分析。其中急性期外科干预37例(41耳)同时综合治疗,单纯明胶海绵贴补13例(14耳),保守治疗8例(8耳)。结果外科干预平均愈合时间17.9天,鼓膜愈合率90.24%;单纯贴补24.3天,治愈率57.14%;保守治疗28.1天,治愈率25.00%。结论特殊类型鼓膜外伤性穿孔依据不同类型采用个性化急性期外科干预并综合治疗可明显提高有效治愈率,缩短穿孔愈合时间。     

内镜下与显微镜下鼓膜大穿孔软骨岛-软骨膜成形术差异分析

目的 对比探讨内镜与显微镜下鼓膜大穿孔软骨岛-软骨膜成形术的异同。方法 慢性化脓性中耳炎静止期大穿孔患者30例,内镜下修补15例,显微镜下修补15例。结果 鼓膜形态：内镜组愈合良好,显微镜组失败3例。听力：内镜组有效10例,显效4例,无效1例;显微镜组有效12例,显效1例,无效2例。结论 鼓膜大穿孔内镜下修补具有损伤小、省时等特点,易于在基层医院开展。     

Errors in the assessment of tympanic membrane perforations

It is commonly stated that operative closure of large perforations of the tympanic membrane is less successful than closure of small perforations. Few authors mention the exact size of the perforations studied, and fewer still give their method of measuring perforations. We describe a photographic method of assessing the size of perforations relative to the total drumhead, measuring them with a computerized digitizing pad. Thirteen temporal bones were selected at random. Perforations of different sizes, shapes and at different sites were fashioned in the tympanic membranes. These were assessed by clinicians of all grades, who were asked to draw the perforations and give estimates of the perforation size as a percentage of the total drumhead. Visual estimates and drawings were compared with a photographic objective method. Gross errors (some in excess of 100%) were apparent in both estimates and drawings. There was a highly significant statistical difference between the objective method and visual estimates and drawings (P < 0.001). Greater clinical experience was not correlated with better performance in estimating the size of perforations.     

Use of a platelet-rich fibrin membrane to repair traumatic tympanic membrane perforations: a comparative study

Objectives: (1) To evaluate the effects of a platelet-rich fibrin (PRF) membrane in the repair of traumatic tympanic membrane (TM) perforations; and (2) to compare the use of a PRF membrane with the paper patch technique with regard to recovery rates, healing time, and correction of the mean air–bone gap.

Methods: A randomized, prospective analysis was performed for 60 patients who were treated for traumatic TM perforations using one of the two methods. Closure rate, speed of healing, and hearing gain were compared between the PRF (Group 1) and paper patch (Group 2) groups.

Results: Closure was obtained in 28 (93%) perforations in Group 1 and 25 (83%) perforations in Group 2 (p?>?0.05). On day 10, full closure of the TM was observed in 24 (80%) patients in Group 1 and 16 (53%) patients in Group 2 (p?p?Conclusions: In comparison with the paper patch method, PRF, a new method, provided more rapid healing with more successful audiological results, and with no requirement for a second procedure.     

耳内镜下金因肽棉片贴补治疗外伤性鼓膜穿孔35例

我科于2009-12-2011-03在耳内镜下对35例外伤性鼓膜穿孔患者采用金因肽棉片贴补治疗,疗效满意,报告如下。1资料与方法1.1临床资料35例外伤性鼓膜穿孔患者中,男26例,女9例;年龄14～65岁;病程1～15d。6例并发中耳感     

An investigation of the microcirculation of the human tympanic membrane with laser-Doppler flowmetry

Summary The present investigation was performed to evaluate the use of laser-Doppler flowmetry as a means for measuring the blood flow of the microcirculation of the human tympanic membrane. The blood cell flux in the microvascular bed of the normal tympanic membrane was measured in healthy subjects. The laser-Doppler output signals continuously recorded showed a steady value ranging from 70 to about 120V, as well as spontaneous oscillations (or rhythmical active vasomotion). Our findings show that the laser-Doppler instrument tested seems to be useful for evaluating blood flow changes in the microcirculation of the human tympanic membrane.     

Spontaneous closure of traumatic tympanic membrane perforation following long-term observation

Background: Traumatic tympanic membrane perforation (TTMP) is usually managed conservatively because most close spontaneously within a few months. Nevertheless, spontaneous closure of TTMP during long-term observation has not been well described in the literature.

Objectives: The present study investigated factors associated with spontaneous closure of TTMP, and the characteristics of cases exhibiting spontaneous closure following long-term observation.

Materials and Methods: The medical records of 40 patients with TTMP who visited the authors’ hospital were retrospectively reviewed.

Results: Spontaneous closure was observed in 27 (67.5%) patients. The healing period was <2 weeks in 6 cases, <4 weeks in 9, <3 months in 5, <6 months in 3, and ≥6 months in 4. All four cases in which spontaneous closure took ≥6 months exhibited a sign of spontaneous closure at 6 months following injury. Perforation in contact with the malleus was associated with a lower frequency of spontaneous closure.

Conclusions and Significance: In TTMP, surgery should be considered in patients who exhibit perforation in contact with the malleus. However, it has also been suggested that long-term observation may be a viable treatment option when a sign of spontaneous closure is observed within 6 months following injury.     

脂肪组织压片修补中大型鼓膜穿孔52例临床分析

目的 探讨耳内镜下自体耳后皮下脂肪组织压片修补中大型鼓膜穿孔的临床疗效。方法 回顾性分析耳内镜下应用自体耳后皮下脂肪组织压片修补中大型鼓膜穿孔52例(52耳)患者的临床资料,观察鼓膜穿孔的愈合及听力改善情况。结果 随访6～12个月,52例均未出现面瘫、味觉减退等手术并发症。52耳中49耳穿孔完全闭合,总治愈率94.2% (49/52),平均听力提高(14.7±3.1)dB;其中,外伤性穿孔31耳,治愈率96.8% (30/31),平均听力提高(14.3±1.6)dB;慢性中耳炎陈旧性穿孔21耳,治愈率90.5% (19/21),平均听力提高(15.4±4.4)dB。结论 脂肪组织压片可用于修补中大型鼓膜穿孔,疗效可靠,愈合率高。此技术优于脂肪嵌入法,扩大了脂肪组织修补鼓膜穿孔的临床应用。     

耳内镜下擦镜纸贴补治疗外伤性鼓膜穿孔

笔者近年来采用耳内镜下擦镜纸贴补治疗外伤性鼓膜穿孔28例,取得良好效果,报告如下。1资料与方法1．1一般资料2008-01—2012—05笔者诊治60例单侧外伤性鼓膜穿孔患者,男11例,女49例;年龄18～36岁,平均（23．44±6．7）岁;病程1～15d,平均（6．2±4．3）d。均无中耳感染。     

Comparative study of epidermal growth factor and observation only on human subacute tympanic membrane perforation

Objective

To compare the effects of epidermal growth factor (EGF) and observation only on human subacute tympanic membrane perforation (TMP).