Clinical Implications of Poloxamer 407 as Packing Material in an Animal Model

2019 ◽  
Vol 24 (2) ◽  
pp. 100-108
Author(s):  
Ji Eun Choi ◽  
Jae-Hun Lee ◽  
So-Young Chang ◽  
Min Young Lee ◽  
Jae Yun Jung
Keyword(s):  
Animal Model ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Packing Material ◽  
Poloxamer 407 ◽  
Gelatin Sponge ◽  
Control Group ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery ◽  
Middle Ear Mucosa

Background: Endoscopic ear surgery has recently increased, but it is still inconvenient and time-consuming to place packing material in the middle ear with one hand. Poloxamer 407 (P407) is a thermo-reversible gel that can be easily administered with one hand into the middle ear cavity in liquid form. Upon warming to body temperature, the gel form of P407 can support the graft in the target position and is known to prevent postsurgical tissue adhesion. Objectives: We aim to investigate the feasibility of P407 as packing material in an animal model. Male Hartley guinea pigs (350 and 400 g) were utilized in this study. Method: The animals were randomly divided into 3 groups according to the packing material: the control group, the P407 group, and the gelatin group. To assess the role of packing material on bacterial colonization, left ears were inoculated with Streptococcus pneumoniae through the tympanic membrane using a 0° endoscope. Five days after inoculation, the middle ear cavity was packed through a transbullar approach using 18% P407 or gelatin in both ears. In the control group, no ear pack was inserted. The tympanic membrane was examined every week using a 0° 1.9-mm endoscope until 6 weeks. Half of the animals in each group were sacrificed 6 weeks after placement of the packing materials. Results: Compared with the absorbable gelatin sponge, the P407 group showed little inflammation or fibrosis in the tympanic membrane and middle ear mucosa regardless of bacterial inoculation. The gelatin group showed severe otorrhea or perforation until 2 weeks in the right ear (2 of 4) and the left ear (1 of 4). Even though the endoscopic findings were similar between both packing groups at 6 weeks, histological analysis showed persistent packing material, inflammatory cells, and fibrosis in the gelatin group compared to the P407 group. Conclusions: This study suggested that P407 is feasible as a packing material to handle with one hand and to prevent adhesion, especially in infected middle ear mucosa. Although there is a lack of data on how well P407 supports grafts, we suggest that P407 could be a candidate for packing material in endoscopic ear surgery.

Does tranexamic acid improve intra-operative visualisation in endoscopic ear surgery? A double-blind, randomised, controlled trial

2019 ◽  
Vol 133 (12) ◽  
pp. 1033-1037 ◽  
Author(s):  
A Das ◽  
S Mitra ◽  
D Ghosh ◽  
S Kumar ◽  
A Sengupta
Keyword(s):  
Tranexamic Acid ◽  
Middle Ear ◽  
External Auditory Canal ◽  
Soft Tissues ◽  
Controlled Trial ◽  
Control Group ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery ◽  
Significant Difference ◽  
Surgical Field

AbstractObjectiveTo assess the effect of tranexamic acid on intra-operative bleeding and surgical field visualisation.MethodsFifty patients undergoing various endoscopic ear surgical procedures, including endoscopic tympanoplasty, endoscopic atticotomy or mastoidectomy, endoscopic ossiculoplasty, and endoscopic stapedotomy, were randomly assigned to: a study group that received tranexamic acid or a control group which received normal saline. The intra-operative bleeding and operative field visualisation was graded using the Das and Mitra endoscopic ear surgery bleeding and field visibility score, which was separately analysed for the external auditory canal and the middle ear.ResultsThe Das and Mitra score was better (p < 0.05) in the group that received tranexamic acid as a haemostat when working in the external auditory canal; with respect to the middle ear, no statistically significant difference was found between the two agents. Mean values for mean arterial pressure, heart rate and surgical time were comparable in both groups, with no statistically significant differences.ConclusionTranexamic acid appears to be an effective haemostat in endoscopic ear surgery, thus improving surgical field visualisation, especially during manipulation of the external auditory canal soft tissues.

Preliminary outcomes of endoscopic middle-ear surgery in 103 cases: a UK experience

2018 ◽  
Vol 132 (06) ◽  
pp. 493-496 ◽  
Author(s):  
C P Yiannakis ◽  
R Sproat ◽  
A Iyer
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Middle Ear Surgery ◽  
Endoscopic Ear Surgery ◽  
Short Term ◽  
Ear Surgery ◽  
Sinus Tympani ◽  
New Concepts ◽  
The Uk ◽  
External Incisions

AbstractBackgroundTotally endoscopic ear surgery and endoscope-assisted microsurgery are still new concepts, with relatively few centres in the UK performing them. Advantages include better visualisation of difficult to reach areas, such as the sinus tympani, and limited external incisions. This paper reports our short-term outcomes for endoscopic middle-ear surgery.MethodsA prospective review was conducted of the first 103 consecutive patients undergoing totally endoscopic ear surgery or endoscope-assisted microsurgery in 1 centre performed by 1 operator. The outcomes assessed were: tympanic membrane healing, audiological data and complications.ResultsTwenty-five patients underwent endoscope-assisted microsurgery, while 78 had totally endoscopic ear surgery. There were no reported cases of dead ear or permanent facial nerve palsy. The average air–bone gap following stapedectomy was 7.38 dB. The tympanic membrane healing rate was 89 per cent.ConclusionOur results confirm that endoscopic middle-ear surgery is safe, and the short-term outcomes are comparable with conventional surgery.

Middle Ear Packing: Comparison Between Merogel and Gelfoam

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P102-P102
Author(s):  
Michael Julian Lipan ◽  
Alava Ibraham ◽  
Simon I Angeli ◽  
Thomas R Van De Water
Keyword(s):  
Tympanic Membrane ◽  
Middle Ear ◽  
Inflammatory Reaction ◽  
Tympanic Membrane Perforation ◽  
Mucosal Inflammation ◽  
Controlled Study ◽  
Control Group ◽  
Otologic Surgery ◽  
Membrane Perforation ◽  
Brainstem Response

Problem Gelfoam has been used for decades in otologic surgery to support grafts and prostheses despite causing fibrosis and adhesions. More biocompatible packing materials could avoid these complications. This study compares Gelfoam with an injectable esterified hyaluronic acid, Merogel, as middle ear packing material after mucosal trauma. Methods A randomized, blinded, controlled study was performed in 17 juvenile guinea pigs. Middle ear surgery with mucosal trauma was performed and middle ears were packed with Merogel or Gelfoam; unpacked contralateral ears were used as controls. Auditory brainstem response (ABR) thresholds were measured in 4 frequencies pre-operatively, and repeated at 1, 2, and 6 weeks postoperatively. Gross analysis measured inflammatory reaction in each group. Statistical analysis was performed using ANOVA followed by post-hoc analysis for ABR thresholds and packing remaining at 6 weeks. Non-prametric tests were used for presence of mucosal inflammation, effusion and tympanic membrane perforation. Results ABR threshold changes from baseline were minor and comparable between the Merogel group and the control group. Threshold change was higher in the Gelfoam group. This difference was seen in each frequency tested at each time interval (all p<0.05). Gross analysis showed 1) Mucosal inflammation higher in the Gelfoam group (p<0.05), 2) Effusions were higher in the Gelfoam group but the difference was not significant (p=0.07), 3) Tympanic membrane perforation was equally rare between groups (p>0.05), 4) Unabsorbed packing was higher in the Gelfoam group (p<0.05); little Merogel was detectable at time of sacrifice. Conclusion Middle ear healing after surgery occurred similarly in the control group and the Merogel group. In contrast, the Gelfoam group demonstrated greater perturbation of hearing and a greater inflammatory reaction. Significance These results support Merogel as an alternative to Gelfoam in middle ear packing after otologic surgery. Support Research grant from Medtronic ENT.

Common drugs used in ENT

2009 ◽  
pp. 347-350
Author(s):  
Rogan Corbridge ◽  
Nicholas Steventon
Keyword(s):  
Inner Ear ◽  
Tympanic Membrane ◽  
Middle Ear ◽  
Otitis Externa ◽  
Round Window ◽  
Acid Reflux ◽  
Tympanic Membrane Perforation ◽  
Active Infection ◽  
Middle Ear Mucosa ◽  
Membrane Perforation

Drugs used in the ear 348 Drugs used in the nose 349 Drugs used in the treatment of acid reflux 350 This group of drugs is widely used for the treatment of otitis externa. Otitis externa 2 drops tds for 10 days Presence of grommet or tympanic membrane perforation due to aminoglycoside ototoxicity in the inner ear. Risk thought to be low in the presence of active infection where the middle-ear mucosa is swollen and the antibiotic is unlikely to reach the inner ear via the round window...

Transtympanic versus intramuscular steroid administration in a histamine-induced inflammatory middle-ear model

2006 ◽  
Vol 121 (7) ◽  
pp. 630-634
Author(s):  
T S Chimona ◽  
J G Panayiotides ◽  
C E Papadakis ◽  
E S Helidonis ◽  
G A Velegrakis
Keyword(s):  
Middle Ear ◽  
Inflammatory Activity ◽  
Mucosal Inflammation ◽  
Control Group ◽  
Middle Ear Mucosa ◽  
Vascular Dilatation ◽  
Group B ◽  
Histamine Challenge ◽  
Inflammatory Component

Objectives: Assessment of the histopathologic effect of transtympanic and intramuscular administration of dexamethasone in an in vivo experimental animal model of middle-ear mucosal inflammation.Methods: Fifty healthy rabbits weighting 1500–1800 g were randomly divided in three groups. In 10 animals (control group), 0.5 ml of a 20 mg/ml histamine solution was injected transtympanically. In 20 rabbits (group A), histamine challenge followed a three day intramuscular pretreatment with dexamethasone at 1 mg/kg per day. In 20 rabbits (group B), histamine challenge followed pretreatment with dexamethasone via a transtympanic route (0.3 ml, 1.2 mg dexamethasone). Middle-ear mucosa was obtained for histopathology 30 minutes after histamine administration. The following parameters were assessed: inflammation, acute inflammatory component, presence of eosinophils, inflammatory activity and fibrosis.Results: Oedema, vascular dilatation and congestion, inflammation, the presence of an acute (polymorphonuclear) inflammatory component, the presence of eosinophils, and inflammatory activity were found to be of a lesser grade in the mucosae of group B. All differences were found to be statistically highly significant (p<0.01) using the Mann–Whitney test.Conclusion: Our findings validate the transtympanic route of dexamethasone administration in counteracting histamine effects.

Correlation of Radiologic Versus Endoscopic Visualization of the Middle Ear: Implications for Endoscopic Ear Surgery

2020 ◽  
Vol 41 (9) ◽  
pp. e1122-e1127 ◽  
Author(s):  
Marco Bonali ◽  
Matteo Fermi ◽  
Matteo Alicandri-Ciufelli ◽  
Francesco Mattioli ◽  
Domenico Villari ◽  
...  
Keyword(s):  
Middle Ear ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery

How we do it: the absorbable gelatin sponge cube, an effective and economical approach to packing in ear surgery

2014 ◽  
Vol 128 (5) ◽  
pp. 475-477 ◽  
Author(s):  
S Fang ◽  
K Argiris ◽  
N Padgham
Keyword(s):  
Similar Efficacy ◽  
Packing Material ◽  
Gelatin Sponge ◽  
Financial Cost ◽  
Ear Surgery ◽  
The Past ◽  
Retrospective Audit ◽  
Robust Evidence

AbstractIntroduction:There is currently a lack of robust evidence on the best form of packing for otological surgery. We describe the use of the absorbable gelatin sponge, a packing material that does not require removal and has the benefit of being considerably cheaper compared to other common forms of ear packing.Methods:A comparison was made of the financial cost of several forms of packing for common otological procedures. In addition, a retrospective audit of complications was undertaken of all patients in whom the absorbable gelatin sponge was used over the past three years.Results:The absorbable gelatin sponge was shown to be cheaper to purchase per unit and also more economical to use. It has been the exclusive form of packing used in 519 procedures over the past three years at the William Harvey Hospital in Ashford (UK), with very few complications noted at the follow-up review.Conclusion:We strongly advocate using the absorbable gelatin sponge, a packing material that is kinder to the patient, has similar efficacy to other forms of packing and is also much cheaper to use compared to other common forms of packing.

Effects of Platelet Activating Factor on Vascular Permeability of the Middle Ear Mucosa

1997 ◽  
Vol 106 (7) ◽  
pp. 604-607 ◽  
Author(s):  
Chung-Ku Rhee ◽  
Yong-Soo Park ◽  
Timothy T. K. Jung ◽  
Steven A. Long ◽  
David Davamony
Keyword(s):  
Vascular Permeability ◽  
Middle Ear ◽  
Normal Saline ◽  
Evans Blue ◽  
Inflammatory Mediator ◽  
Otitis Media With Effusion ◽  
Platelet Activating Factor ◽  
Control Group ◽  
Middle Ear Mucosa ◽  
Potent Inflammatory Mediator

Platelet activating factor (PAF), a potent inflammatory mediator, seems to play a significant role in the pathogenesis of otitis media with effusion (OME), along with other inflammatory mediators such as leukotrienes and prostaglandins. The purpose of this study was to investigate the effect of PAF on the vascular permeability of middle ear mucosa, in an experimental OME model using chinchillas. We injected PAF in doses of 1, 4, 8, and 16 μg and normal saline as a control into the bullae of chinchillas. Vascular permeability was measured by the Evans blue vital dye technique. All the PAF-injected animals showed a significant increase in middle ear vascular permeability compared to the control group. This study demonstrated that PAF in the middle ear cavity contributes significantly to the development of OME by increasing the vascular permeability of the middle ear mucosa.

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

2016 ◽  
Vol 21 (4) ◽  
pp. 254-260
Author(s):  
Selin Ünsaler ◽  
Bora Başaran ◽  
Şule Öztürk Sarı ◽  
Eyüp Kara ◽  
Kemal Değer ◽  
...  
Keyword(s):  
Middle Ear ◽  
Auditory Brainstem ◽  
Contralateral Side ◽  
Auditory Brainstem Responses ◽  
Control Group ◽  
Ear Surgery ◽  
Significant Difference ◽  
Intratympanic Injection ◽  
Temporal Bones ◽  
Histopathologic Findings

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.

Endoscopic ear surgery: a hot topic?

2017 ◽  
Vol 131 (2) ◽  
pp. 117-122 ◽  
Author(s):  
S Mitchell ◽  
C Coulson
Keyword(s):  
Middle Ear ◽  
Descriptive Analysis ◽  
Relevant Literature ◽  
Heat Exposure ◽  
Middle Ear Surgery ◽  
Endoscopic Ear Surgery ◽  
Ear Surgery ◽  
Potential Factors ◽  
Negative Impacts ◽  
Published Research

AbstractObjectives:To summarise published research investigating maximal temperatures associated with endoscopes used in otology. Possible thermal issues surrounding the use of endoscopes in middle-ear surgery are discussed, and recommendations regarding the safest ways to use endoscopes in endoscopic ear surgery are made.Methods:A non-systematic review of the relevant literature was conducted, with descriptive analysis and presentation of the results.Results:There are currently no reports of any temperature-related deleterious effects in patients having undergone endoscopic ear surgery. There is debate regarding heat issues in endoscopic ear surgery, with a limited body of work documenting potential negative impacts of middle-ear heat exposure from endoscopes. The diameter of endoscope, type of light source used, distance from endoscope tip and duration of exposure are highlighted potential factors for high temperatures in endoscopic ear surgery.Conclusion:There is a trend towards endoscopes being used routinely in ear surgery. Simple practice points are recommended to minimise potential thermal risks.

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