Platelet-Rich Plasma Fat Graft versus Cartilage Perichondrium for Repair of Medium-Size Tympanic Membrane Perforations

Objectives To compare clinical and audiologic outcomes among patients who underwent myringoplasty with fat graft enriched with platelet-rich plasma and cartilage perichondrium graft. Study Design Prospective randomized controlled study. Setting Department of Otolaryngology–Head and Neck Surgery, Tanta University, Egypt. Subjects and Methods The study comprised 50 patients who had tympanic membrane perforation of medium size (25%-50% of its surface area) without evidence of active otitis media or ossicular abnormalities and who had surgery between December 2016 and December 2017. Patients randomly underwent myringoplasty with fat graft enriched with platelet-rich plasma (group 1) or cartilage perichondrium graft (group 2). Results Twenty-five patients were included in each group. Rates of successful closure at 3-month follow-up were 88% (group 1) and 92% (group 2). The mean overall improvement in pure tone average was 18.08 dB (95% CI, 16.9-19.25) for group 1 and 18.24 dB (95% CI, 16.94-19.53) for group 2. Conclusion Fat graft enriched with platelet-rich plasma can be recommended as an alternative choice for first-line treatment of medium-size central perforations of the tympanic membrane, with healing and hearing results comparable to those of conventional cartilage perichondrium myringoplasty.

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Role of nasal decongestants in spontaneous healing of traumatic tympanic membrane perforation

Nepalese Journal of ENT Head and Neck Surgery ◽

10.3126/njenthns.v5i1.16854 ◽

2017 ◽

Vol 5 (1) ◽

pp. 14-16

Author(s):

Shiwani Rai ◽

K. Koirala ◽

V. Sharma

Keyword(s):

Tympanic Membrane ◽

Tympanic Membrane Perforation ◽

Complete Healing ◽

Controlled Study ◽

Spontaneous Healing ◽

Nasal Decongestants ◽

Membrane Perforation ◽

Group 2 ◽

Group 1

Objective: To study the role of nasal decongestants in spontaneous healing of traumatic tympanic membrane perforation.Material and Methods: A prospective single blinded, randomized controlled study was carried out in the department of ENT, Manipal College of Medical Sciences, Pokhara, Nepal. Patients with traumatic tympanic membrane perforation were divided into two groups; those receiving nasal decongestants along with conservative measures (Group1) and those receiving conservative measures only (Group2). Healing of tympanic membrane was compared in between these groups at 1 and 3 months. Statistical analysis was done using SPSS 20.Results: There were 30 patients in group 1 and 28 patients in group 2. The mean age of the study population was 26.98 (SD= 7.53). The M: F ratio in group 1 was 0.58:1 and that in group 2 was 0.56:1. Complete healing was seen in 25 (83%) patients in group 1 and 16 (57.1%) patients in group 2 at the end of 1 month (P=0.029). Similarly, healing was seen in in 29 (96.7%) patients in group 1 and 21 (75%) patients in group 2 at the end of 3 months (P=0.023).Conclusion: Routine use of nasal decongestants increases the chances of spontaneous healing of traumatic tympanic membrane perforations.

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Outcome of Myringoplasty in Underlay Technique

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v24i2.44173 ◽

2019 ◽

Vol 24 (2) ◽

pp. 131-136

Author(s):

Md Abdur Razzak ◽

KM Mamun Murshed ◽

AKMA Sobhan ◽

Md Rakib Hossain ◽

SM Nafeez Imtiaz

Keyword(s):

Success Rate ◽

Tympanic Membrane ◽

Surgical Techniques ◽

Neck Surgery ◽

Tympanic Membrane Perforation ◽

College Hospital ◽

Medical College ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Age Range

Background: Myringoplasty is one of the surgical techniques for the management of chronic supportive otitis media with permanent perforation of tympanic membrane. It is defined as simple surgical repair of tympanic membrane perforation without doing ossicular reconstruction. Objective: To determine the success rate of myringoplasty and to examine whether the hearing improvement is a potential indication for surgery. Methods: This study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, Shaheed Suhrawardy Medical College Hospital from January 2017 to December 2017 and 100 patients who underwent myringoplasty in this period were analyzed. About 100 patients with dry central tympanic membrane perforations of various size were included in this study Results: Myringoplasty was performed in 100 patients. Male were (45%) and females were (55%).Twenty one (7%) of them belonged to age group of 10-20 years, 31 (31%) were in the age range of 21-33 years, 38(38%) were the age range 31-40 years while 24 (24%) aged between 41-50 years with mean age of 26.32 ±S.D 9.59 years. Overall success rate of graft uptake was noted in 88 (88%) out of 100 cases Conclusion: Myringoplasty is a safe surgical procedure in achieving intact tympanic membrane and to improve the hearing loss. Therefore, underlay technique being technically simple should be preferred, but the ultimate decision about the technique to be employed depends on the surgeons preference and the site of perforation Bangladesh J of Otorhinolaryngology; October 2018; 24(2): 131-136

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Platelet-rich plasma improves healing of tympanic membrane perforations: experimental study

The Journal of Laryngology & Otology ◽

10.1017/s0022215108003848 ◽

2008 ◽

Vol 123 (5) ◽

pp. 482-487 ◽

Cited By ~ 23

Author(s):

E Erkilet ◽

M Koyuncu ◽

S Atmaca ◽

M Yarim

Keyword(s):

Tympanic Membrane ◽

Histopathological Examination ◽

Platelet Rich Plasma ◽

Healing Time ◽

Tympanic Membrane Perforation ◽

Control Group ◽

Tympanic Membrane Perforations ◽

Significant Difference ◽

Membrane Perforation ◽

Tympanic Membranes

AbstractObjective:The aim of this study was to investigate the effect of local application of platelet-rich plasma to perforated rat tympanic membranes, in terms of healing time and histopathological outcome.Methods:Eighty-eight tympanic membranes of 44 rats were given a standard 3 mm perforation, and platelet-rich plasma was applied to the right tympanic membrane perforations. The left tympanic membranes were left to heal spontaneously, as controls. The 44 rats were divided into two groups. In group one, comprising 20 rats, daily otomicroscopic examination of the tympanic membrane perforations was performed. The 24 rats in group two were subdivided into four subgroups of six rats each; these subgroups were sacrificed sequentially on days three, seven, 14 and 28 for histopathological examination, regardless of tympanic membrane healing stage.Results:In group one, the mean tympanic membrane healing times for tympanic membrane perforations receiving platelet-rich plasma and controls were respectively 10.2 ± 2.1 and 13.0 ± 2.9 days (mean ± standard deviation). This difference was statistically significant (p < 0.001). In group two, histopathological evaluation of tympanic membrane perforation healing at days three, seven, 14 and 28 did not reveal any statistically significant difference, individually or within the four groups as a whole.Conclusion:These findings suggest that earlier healing of tympanic membrane perforations occurred in the platelet-rich plasma group compared with the control group. These findings suggest that platelet-rich plasma is effective in accelerating tympanic membrane perforation healing, and that it may be effective in human subjects, particularly as it is an autologous material.

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Effect of Silver Nitrate and Epidermal Growth Factor on Nonhealing Tympanic Membrane Perforations: A Randomized Controlled Study

Annals of Otology and Neurotology ◽

10.1055/s-0037-1612644 ◽

2018 ◽

Vol 01 (01) ◽

pp. 029-033

Author(s):

Vikram Bhat ◽

Bijiraj Veetil ◽

Vidyashree Mathad

Keyword(s):

Growth Factor ◽

Epidermal Growth Factor ◽

Silver Nitrate ◽

Tympanic Membrane ◽

Chronic Otitis Media ◽

Tympanic Membrane Perforations ◽

Epidermal Growth ◽

Group 2 ◽

Chemical Cautery ◽

Group 1

Abstract Introduction Most tympanic membrane perforations in chronic otitis media require surgical myringoplasty for closure. This study aimed to find out a simple nonsurgical outpatient procedure to close these perforations that could reduce the hospital stay, medical cost, and morbidity in these patients. Materials and Methods The study was conducted in a tertiary referral hospital in a single-blind randomized controlled trial design with two groups, each with a sample size of 40 ears. Only small-size central nonhealing traumatic and chronic otitis media perforations were recruited. Pure tone audiometry and otomicroscopy were performed in all eligible patients who consented to take part in the study. Group 1 was treated with silver nitrate chemical cautery alone. Group 2 received epidermal growth factor gel application in addition to chemical cautery. Both the groups were followed up for a minimum period of 3 months. The same investigations were performed during follow-up. Results and Observations The outcome was considered a success whether there was closure of perforation or reduction in the size of perforation. The success rate of these nonhealing perforations was found to be significantly higher in group 2 (71.42%) than in group 1 (47.36%). Hearing gain was observed in closed perforations of both the groups. Conclusion Epidermal growth factor application enhances the healing effect of silver nitrate in small nonhealing tympanic membrane perforations. The encouraging results of epidermal growth factor have vast applications in improving outcomes of surgical myringoplasty and treatment of residual perforations remaining after the same.

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Fat graft myringoplasty in children – a safe and successful day-stay procedure

The Journal of Laryngology & Otology ◽

10.1017/s002221510013659x ◽

1997 ◽

Vol 111 (2) ◽

pp. 106-108 ◽

Cited By ~ 39

Author(s):

R. B. Mitchell ◽

Kevin D. Pereira ◽

Rande H. Lazar

Keyword(s):

Tympanic Membrane ◽

Otitis Media With Effusion ◽

Tympanic Membrane Perforation ◽

Successful Outcome ◽

Fat Graft ◽

Graft Material ◽

Surgical Closure ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Ventilation Tubes

AbstractThe surgical closure of dry tympanic membrane perforations in children remains a controversial issue due to conflicting opinions on the appropriate technique, graft material and success rate. We present a review of 342 children who underwent fat graft myringoplasty as a day-stay procedure over a six-year period. Successful closure of the tympanic membrane perforation was achieved in 92 per cent of ears. Subsequent recurrent otitis media with effusion required insertion of ventilation tubes in 12 per cent. No relationship was observed between the age of the child and a successful outcome. We conclude that day-stay fat graft myringoplasty is a safe and successful procedure which results in a dry and safe ear in the majority of children.

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Comparative study between post-aural and per-meatal approach type-1 tympanoplasty.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.02.5154 ◽

2021 ◽

Vol 28 (01) ◽

pp. 125-130

Author(s):

Tahir Hussain Khan ◽

Ashfaq Hussain Rana ◽

Sohail A. Malik

Keyword(s):

Comparative Study ◽

Tympanic Membrane ◽

P Value ◽

Medical College ◽

Tympanic Membrane Perforations ◽

Time Period ◽

Group 2 ◽

Post Aural Approach ◽

Mean Time ◽

Group 1

Objective: To compare the results after tympanoplasty between post-aural and per-meatal approach. Study Design: Comparative study. Setting: Social Security Landhi Hospital, Karachi. Al-Tibri Medical College & Hospital (Isra University Karachi Campus), old thana Malir, Karachi. Period: July 2017 till June 2018. Material & Methods: In this study, 76 Patients of both genders with dry tympanic membrane perforations were included. They were aged between 18 to 40 years. Period of research was one year, study was started since July 2017 till June 2018. Patients were distributed into two groups, group-1 and group-2. 38 patients were included in every group. In group-1, post-aural approach tympanoplasty was done. In group-2, per-meatal approach tympanoplasty was performed. Observed results of both procedures after 1st post-operated day, after 1st post-operated week, after 1st month and after 2nd month post operatively. Variables were intensity of pain, bleeding, PTA (Ac, BC and AB-gap measured by tympanometer) and duration (time period) of surgical procedure. Result: In group-1(post-aural approach tympanoplasty), out of 38 patients, 36 patients had intact grafted tympanic membrane while in group-2 (per-meatal approach tympanoplasty), 37 patients had intact grafted tympanic membrane and 1 patient had residual perforation. Smaller amount of bleeding was noted during surgery and post-operative in group-2, in comparison with group-1. All the dressing gauze were dry in per-meatal approach tympanoplasty group (group-2). Mean time period of surgery was less in per-meatal tympanoplasty (group-2) 65.1 + 3.7 mins and mean time period of post-aural tympanoplasty (group-1) was 82.0 + 5.6 mins. P value was found to be significant i.e. < 0.001. Consumed time period of surgery was also decreased in per-meatal tympanoplasty (group-2). After tympanoplasty, hearing status was also enhanced on PTA in both groups. Post- operatively, it was observed that AB gap was reduced in both groups. On 1st post -operative day, Weber test was done, vibrating sound was heard (lateralized) in post-operated ears which ensured the safety of inner ear apparatus. Conclusion: Results of post-aural and per-meatal tympanoplasty were approximately same but per-meatal approach tympanoplasty is superior as it took shorter amount of time period, minimum post- operative pain and post- operative bleeding.

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Studying the result of underlay myringoplasty using platelet-rich plasma

The Journal of Laryngology & Otology ◽

10.1017/s0022215118001846 ◽

2018 ◽

Vol 132 (11) ◽

pp. 990-994 ◽

Cited By ~ 1

Author(s):

S P S Yadav ◽

J S Malik ◽

P Malik ◽

P K Sehgal ◽

J S Gulia ◽

...

Keyword(s):

Tympanic Membrane ◽

Platelet Rich Plasma ◽

Hearing Threshold ◽

Surgical Techniques ◽

Control Group ◽

Type I ◽

Preparation Technique ◽

Fascia Graft ◽

Group 2 ◽

Group 1

AbstractObjectivePerforations of the tympanic membrane are treated with various surgical techniques and materials. This study aimed to determine the efficacy of platelet-rich plasma during underlay myringoplasty.MethodsThe study included 40 patients. Autologous platelet-rich plasma was applied in-between temporalis fascia graft and tympanic membrane remnant during underlay myringoplasty in group 1 (n = 20). The outcome was evaluated after three months and compared with group 2 (n = 20), a control group that underwent routine underlay tympanoplasty.ResultsAfter three months’ follow up, graft uptake was 95 per cent in group 1 and 85 per cent in group 2 (p < 0.03). Mean hearing threshold gain was 18.62 dB in group 1 and 13.15 dB in group 2. This difference was statistically significant (p < 0.01).ConclusionPlatelet-rich plasma, with its ease of preparation technique, availability, low cost, autologous nature and good graft uptake rate, justifies its use in tympanoplasty type I procedures.

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What is better for rotator cuff tendinopathy: dextrose prolotherapy, platelet-rich plasma, or corticosteroid injections? A randomized controlled study

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00040-3 ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Hala M. Abd Elsabour Sabaah ◽

Mary A. Nassif

Keyword(s):

Rotator Cuff ◽

Platelet Rich Plasma ◽

Tendon Healing ◽

Controlled Study ◽

Clinical Trial Registry ◽

Western Ontario Rotator Cuff ◽

Group 3 ◽

Group 2 ◽

Rotator Cuff Tendinopathy ◽

Group 1

Abstract Background Rotator cuff tendinopathy (RCT) is a leading cause of shoulder pain and disability. Management is mainly conservative, but the limited ability of tendons to regenerate is the main cause of unsatisfactory results. So, we conducted our study to compare the efficacy of deep prolotherapy (glucose 25%), platelet-rich plasma (PRP), and betamethasone corticosteroid for treatment of RCT to find the most effective one based on clinical, functional, and radiological assessment. Results Regarding visual analog scale (VAS), it was significantly (p < 0.001) improved after injection among group 1 (prolotherapy group) and group 3 (steroid group) patients, while no significant improvement was noted among group 2 (PRP group) (p = 0.212) patients. The Western Ontario Rotator Cuff (WORC) Index significantly improved among the studied groups (p < 0.001, p = 0.049, and p < 0.001, respectively) after injection. Regarding the range of motion (ROM), a significant improvement (p = 0.029) was achieved in group 1 after injection but no significant improvements were noted among group 2 and 3 patients (p = 0.529 and 0.121, respectively). There was a significant improvement among group 1 and 2 patients (p < 0.001 and p = 0.020, respectively) regarding the grade of tendon lesions but no improvement occurred among group 3 patients (p = 0.470). Conclusion Prolotherapy injections improve shoulder ROM, VAS, WORC index, and rotator cuff tendon healing while PRP injections improve WORC index and tendon healing but steroid injection has no effect on healing. Trial registration PACTR202005610509496. Retrospective registration on May 25, 2020, Pan African Clinical Trial Registry.

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Study of effect of 1% sodium hyaluronate application on tympanic membrane perforation

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20183695 ◽

2018 ◽

Vol 4 (5) ◽

pp. 1246

Author(s):

Dimple Sahni ◽

Bikramjit Singh ◽

K. S. Uppal ◽

Sanjeev Bhagat ◽

Dinesh Sharma ◽

...

Keyword(s):

Tympanic Membrane ◽

Sodium Hyaluronate ◽

Pure Tone Audiometry ◽

Tympanic Membrane Perforation ◽

Medium Size ◽

P Value ◽

Beneficial Effects ◽

Tympanic Membrane Perforations ◽

Membrane Perforation ◽

Traumatic Origin

Background: Topical applications of hyaluronic acid have been found to have beneficial effects on closure of tympanic membrane perforations. The aim of the study was to evaluate the role of 1% sodium hyaluronate in the repair of small or medium sized dry central tympanic membrane perforation and improvement in hearing following closure of tympanic membrane perforation.Methods: 50 patients with dry central perforation of inflammatory or traumatic origin were taken up. Maximum of 4 applications of 1% sodium hyaluronate were given at weekly intervals. Final mapping for closure of tympanic membrane perforation and hearing assessment was done after 3 months. Results: 26 perforations closed completely while 18 perforations showed significant reduction in size. Thus 44 or 88% perforations showed positive response to 1% sodium hyaluronate application. Hearing Improvement was observed on pure tone audiometry with the average hearing gain in patients after complete closure of tympanic membrane perforation was 12.40 dB with p value of 0.001.Conclusions: Study showed the beneficial effects of 1% sodium hyaluronate application in closure of small and medium size perforations of tympanic membrane perforation and improvement in hearing.

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A comparative study between fat myringoplasty and temporalis fascia tympanoplasty in moderate to large central perforation of pars tensa of tympanic membrane

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20174321 ◽

2017 ◽

Vol 3 (4) ◽

pp. 997

Author(s):

Kirti P. Ambani ◽

Rachana W. Gangwani ◽

Bhavya B. M. ◽

Sanket D. Vakharia ◽

Ashish U. Katarkar

Keyword(s):

Tympanic Membrane ◽

Postoperative Infection ◽

Bone Conduction ◽

Fat Graft ◽

Graft Material ◽

Temporalis Fascia ◽

Membrane Repair ◽

Tympanic Membrane Perforations ◽

Fascia Graft ◽

Group 2

Background: To compare the efficacy between fat graft (FG) and temporalis fascia (TF) graft in tympanic membrane perforations larger than 4mm size or involvement of >25% of tympanic membrane.Methods: This prospective study was carried out during December 2015 to January 2016, for a period of 13months at our Otolaryngology Department. All study patients, who fit into inclusion and exclusion criteria, were divided into two groups according to the type of graft material taken. In group- 1temporalis fascia (TF) graft was taken while in group- 2 fat graft (FG) was taken. An evaluation of hearing was done with full Audiometric and Eustaschian tube function testing. All laboratory preoperative testing was done. Postoperative follow up was done at 2nd, 3rd and 5th month’s period and sos, graft status and hearing evaluation with PTA for all four frequencies 500, 1000, 2000 and 4000 Hz with air conduction and bone conduction thresholds were recorded and compared with preoperative PTA records in both groups. Results: In TF group total 24 (80%) patients had graft uptake, 4 (13.3%) patients had residual perforation and 2 (6.6%) patients had graft failure due to postoperative infection. In FG group total 16 (53.3%) patients had graft uptake, 6 (20%) patients had graft medialised and necrosed, 6 (20%) patients had residual perforation and 2 (6.6%) patient had graft rejection due to postoperative infection. Graft uptake rate in group 1 was 80% while in group 2 was 53.3%. Mean preoperative ABG in TF group was 25±17 dB and mean postoperative ABG was 10±02 dB, in fat graft technique mean preoperative ABG was 25±13 dB and mean postoperative ABG was 16±15 dB. Fat graft technique is simple, quick and minimally invasive. It doesn’t require middle ear manipulation.Conclusions: There is no ideal material for tympanic membrane repair but for moderate to large perforation temporalis fascia graft is better than fat graft in terms of healing and hearing outcomes but considering morbidity fat gives less morbidity.

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