Hybrid Hydrogel Composed of Hyaluronic Acid, Gelatin, and Extracellular Cartilage Matrix for Perforated TM Repair

A novel series of composite hydrogels, built from the three components 1), hyaluronic acid methacryloyl (HAMA); 2), gelatin methacryloyl (GelMA), and 3), extracellular cartilage matrix (ECM), was prepared and studied regarding the possible utility in the surgical repair of damaged (perforated) tympanic membrane (TM). Noteworthy is component 3), which was harvested from the ribs of α-1,3-galactosidyltransferase-knockout (α-1,3 GalT-KO) pigs. The absence of α-1,3-galactosyl glycoprotein is hypothesized to prevent rejection due to foreign-body immunogenicity. The composite hydrogels were characterized by various aspects, using a variety of physicochemical techniques: aqueous swelling, structural degradation, behavior under compression, and morphology, e.g., in vitro biocompatibility was assessed by the CCK-8 and live–dead assays and through cytoskeleton staining/microscopy. Alcian blue staining and real-time PCR (RT-PCR) were performed to examine the chondrogenic induction potential of the hydrogels. Moreover, a rat TM defect model was used to evaluate the in vivo performance of the hydrogels in this particular application. Taken together, the results from this study are surprising and promising. Much further development work will be required to make the material ready for surgical use.

632 Myringoplasty Outcomes from A 5 Year Single Surgeon Experience at A District General Hospital

Introduction Myringoplasty is an operation to repair a perforated tympanic membrane. A UK based myringoplasty national audit showed the overall closure rate for myringoplasty nationally was 89.5% (90.6% for primary surgery and 84.2% for revision surgery). This study sought to compare the myringoplasty outcomes in terms of achievement of tympanic membrane closure for a single surgeon over the period of 5 years against the national standard. Method Data was collected retrospectively. 68 suitable myringoplasty cases were identified as being done under a single surgeon between 2014 and 2019. Operation notes, discharge letters, audiograms and clinic letters were analysed. Results The overall closure rate was 97% (66/68) and significantly higher than the national standard (p = 0.0210), the primary closure rate was 98% (53/54) and significantly higher than the national standard (p = 0.0287) and the revision closure rate was 93% (13/14), but not significantly higher than the national standard (p = 0.1872). Conclusions This surgeon uses a posterior auricular approach, combined with mastoidectomy with temporalis fascia graft underlay. We suggest that his particular surgical technique contributed to the positive outcomes quoted.

Chronic otorrhoea, otalgia and hearing loss not responding to antibiotics and tympanoplasty surgery

Chronic otorrhoea from a tympanic membrane perforation is common. We present the case of a patient who had already received seemingly adequate treatment for his condition in the past. Yet, he presented to our outpatient clinic with worsening otalgia and otorrhoea, progressive hearing loss and a new tympanic membrane perforation. After a thorough otological evaluation, the patient’s medical history and the histological specimen from a previous operation were reviewed. The findings met the diagnostic criteria of eosinophilic otitis media. After treatment with topic triamcinolone through the perforated tympanic membrane, the patient’s otalgia subsided, hearing levels were improved and the size of the tympanic membrane perforation decreased.

Histological evaluation of effect of PDGF-rich plasma on the tympanic membrane

Introduction. Тo study the microscopic picture of the tissues of the perforated tympanic membrane after the introduction of blood plasma enriched with platelet growth factors into the perforated area of the tympanic membrane in the experiment.Materials and methods. 36 rats (72 tympanic membranes) were examined. The animals were divided into 2 groups, the main and the control. The tympanic membrane was perforated in rats of both groups using sterile play. Animals of the main group were injected with a single application of autoplasm of blood enriched with platelet growth factors into the area of perforation of the tympanic membrane. The animals of the control group underwent only dynamic observation. The rats were withdrawn from the experiment in batches of 6 individuals on day 5, 10, 15 after the tympanic membrane perforation, then a histological assessment of the tissue regeneration of the tympanic membranes was performed. Results. In animals of the main group on the 5th day after perforation of the tympanic membrane, edema and disorganization of connective tissue were significantly less frequently recorded than in animals of the control group (p ≤ 0.05). Fibroblastic infiltration of tympanic membrane tissues was significantly more often observed in rats of the main group compared with rats in the control group (p ≤ 0.05). In rats of the main group on the 10th day after perforation of the tympanic membrane, edema and disorganization of the connective tissue of the tympanic membranes were noted significantly less frequently than in rats of the control group (p ≤ 0.05). Signs of fibroblastic infiltration and neoangiogenesis at the same time in animals of the main group were revealed significantly more often, in contrast to rats in the control group (p ≤ 0.05). In animals of the main group, on the 15th day after perforation of the tympanic membrane, fibroblastic infiltration and neoangiogenesis were revealed in all cases of observation, which significantly exceeded the corresponding indicators in the control group, and leukocyte infiltration in rats of the main group, in contrast to the previous stages of the study, was noted significantly less frequently. than in rats of the control group (p ≤ 0.05).Conclusion. Earlier and complete regeneration of damaged tissues of the tympanic membrane under conditions of its traumatic perforation was noted in rats of the main group under the influence of PCOTFR. In rats of the main group, more organized collagen fibers, the presence of basophilic leukocytes, signs of neoangiogenesis, and extensive fields of fibroblasts were visualized.

Antero-inferior tympanic visibility during microscopy

<p class="abstract"><strong>Background:</strong> The antero-inferior recess of the ear canal is not visible to the otologist, thereby effecting proper placement of the graft and thereby affecting its uptake .The visibility of this region in the adult population is assessed.</p><p class="abstract"><strong>Methods:</strong> The quadrants of tympanic membrane were examined in 60 subjects with perforated tympanic membrane undergoing tympanoplasty. The study was conducted in the department of ENT-HNS (ear, nose and throat-head and neck surgery), Dayanand Medical College and Hospital, Ludhiana. </p><p class="abstract"><strong>Results:</strong> With the microscope in 48 (80%) entire perforation could be visualized and in 12 (20%) margins were not in the line of view. 5 perforations were posterior superior and 12 were total perforations. Otoendoscope examination with zero degree could show the entire margin of the perforation.</p><p class="abstract"><strong>Conclusions:</strong> In 80% population the antero-inferior quadrant of the tympanic membrane is accessible to straight vision of the microscope.</p>

A rare cause of acute tympanic membrane perforation: a case report

<p class="abstract">This is a case report of 57yrs old gentleman who presented to accident and emergency department with complaints of sudden onset of left earache, tinnitus, feeling of fullness in the ear which he claimed to start following an episode of sudden sneezing, while he was trying to blow his nose by pinching it with 2 fingers. The tympanic membrane was ruptured. He was managed conservatively with analgesics. Spontaneous and complete healing of the perforated tympanic membrane occured within one month of follow up. It was shown that an episode of sneezing with nose closed can build up such a high pressure in the middle ear which can perforate a tympanic membrane.</p>

Penerapan Case Based Reasoning (Cbr) Pada Sistem Pakar Diagnosa Penyakit Otitis Media Supuratif Kronis (OMSK) Pada Orang Dewasa

Chronic Suppurative Otitis Media (OMSK) is an infection of middle ear mucosal inflammation with perforated tympanic membrane and secret from the ear continuously, formerly called otitis media perforate (OMP) in everyday congek. Chronic suppurative otitis media (OMSK) is commonly found in lower middle-class people, and leads to increased costs for treatment. Therefore required a tool or system that has the ability of a doctor in diagnosing the disease. The expert system is used not to replace the physician's function but will be used only as a complement to a system and aids. An expert system is a system capable of mimicking the reasoning of a computer expert to solve problems as is usually done by experts. The method used in this expert system uses case-based reasoning (CBR) method, since this method yields the value of kmiripan a case with the former by recalling similar events that have occurred in the past then use the knowledge or information to solve a new problem, or in other words solve the problem by adopting solutions that have been used in the past.