Fetal Bovine Collagen Grafts for Repair of Tegmen Defects and Encephaloceles Via Middle Cranial Fossa Approach.

To evaluate the use of commercially available allogenic dural graft materials made of fetal bovine collagen, we present an analysis of our case series with use of autologous and allogenic graft materials. Patients who underwent surgical repair of a tegmen tympani defect associated with ipsilateral conductive hearing loss and cerebrospinal fluid (CSF) otorrhea using a middle cranial fossa (MCF) approach from 2004 to 2018 at Loyola University Medical Center were included. Resolution of CSF otorrhea, audiologic outcomes, facial nerve preservation, and surgical complications was analyzed. Thirty-three patients with an average age of 55.3 years (range: 21-78, standard deviation [SD]: 12.9) and body mass index of 34.4 (range: 22-51, SD: 7.4) underwent an MCF repair of a tegmen and dural defect. All patients presented with CSF otorrhea and conductive hearing loss ipsilateral to the defect. Repairs were made with combinations of allograft and autograft in 17 cases, allograft only in 15 cases, and autograft only in 5 cases. Improvement in hearing was noted in 33 cases, and resolution of CSF otorrhea was noted in 36 cases; one patient required repeat surgery which resolved CSF otorrhea. Three patients had minor complications; all these were in the autograft group. The MCF approach coupled with the use of fetal bovine collagen grafts is a safe and viable method to repair tegmen tympani and associated dural defects with salutary outcomes and low morbidity.

Middle ear mucosal regeneration with three-dimensionally tissue-engineered autologous middle ear cell sheets in rabbit model.

The likelihood of recurrent retraction and adhesion of newly formed tympanic membrane is high when middle ear mucosa is extensively lost during cholesteatoma and adhesive otitis media surgery. If rapid postoperative regeneration of the mucosa on the exposed bone surface can be achieved, prevention of recurrent eardrum adhesion and cholesteatoma formation, for which there has been no definitive treatment, can be expected. Suture-less transplantation of tissue-engineered mucosal cell sheets was examined immediately after the operation of otitis media surgery in order to quickly regenerate middle ear mucosa lost during surgery in a rabbit model. Transplantable middle ear mucosal cell sheets with a three-dimensional tissue architecture very similar to native middle ear mucosa were fabricated from middle ear mucosal tissue fragments obtained in an autologous manner from middle ear bulla on temperature-responsive culture surfaces. Immediately after the mucosa was resected from middle ear bone bulla inner cavity, mucosal cell sheets were grafted at the resected site. Both bone hyperplasia and granulation tissue formation were inhibited and early mucosal regeneration was observed in the cell sheet-grafted group, compared with the control group in which only mucosal removal was carried out and the bone surface exposed. This result indicates that tissue engineered mucosal cell sheets would be useful to minimize complications after the surgical operation on otitis media and future clinical application is expected.

Free Bioverit II implants coated with a nanoporous silica layer in a mouse ear model-- a histological study.

The objective of this study is to evaluate the suitability of a mouse middle ear model for testing ossicular replacement materials. Twenty-four BALB/c mice are implanted with the bioglass-ceramic Bioverit II which is coated with a silica-nanostructure or with plain Bioverit II as a control. After 2, 6, and 12 weeks, 4 mice per group are sacrificed and both complete petrous bones are analyzed histologically. All implants revealed in situ an incipient growth of thin connective tissue layers over the surface, followed by a spreading of epithelial cells. The osseogenic response which is increasing with time is more intense in the coated Bioverit II specimens. The absence of inflammatory cells suggests an excellent biocompatibility of the silica nano structure. As the results are comparable to a study with the same materials in rabbits, the mouse model described is highly suitable for evaluation of new ossicular replacement materials. Additionally, by gene expression analysis a more detailed insight into cellular interactions of the middle ear is offered.

Transplantes e implantes en la cirugía del oído medio / Transplant and you implants in the middle ear

El autor muestra en el presente trabajo las diferentes opciones que hay de manejo de la cadena osicular del oído medio por alteraciones de esta en diferentes circunstancias. Se hace mensión de las posibilidades de utilización de diferentes elementos para la reconstrucción de la cadena osicular como pueden ser (hueso, diente, cartilago, metales, cerámicas, polietileno, cemento dental, etc.) muestra en el presente artículo la s estadísticas en este tipo de reconstrucción.

The author shows different options in the ossicular chain management because in different circumstances. He describes some possibilities about using a variety of elements for the ossicular chain reconstruction such as bone, teeth, polythelene, metals, ceramic, cartilage, dental clay, etc. Finally statistics abut tis kind of reconstruction is also detailed.

The use of vascular flaps in middle ear surgery.

OBJECTIVE: This study aimed to evaluate improved surgical outcomes from middle and external ear surgery using local vascular flaps to enhance tissue healing. STUDY DESIGN: The study design was a review of the design and clinical trials of three soft tissue flaps: the middle temporal flap (MTF), the middle temporal canal flap (MTCF), and the wing flap. All derive axial vascular supply from the middle temporal vessels. SETTING: The study was performed at a single surgeon's private otologic practice. PATIENTS: A total of 319 patients were treated from 1991-1996: MTF in 223, MTCF in 38, and wing flap in 58. The average case maturity was 2.25 years. Most cases were mastoidectomy reconstruction or intact canal wall mastoidectomy. INTERVENTION: The flaps are used to introduce an improved blood supply to key repair sites in the middle and external ear. MAIN OUTCOME MEASURES: Canal skin breakdown, chronic myringitis, and chronic otitis externa were measured. RESULTS: Dehiscence rates fell from 15-5% and myringitis rates fell from 15-4%. Thicker, vascular canal skin was the usual result. CONCLUSIONS: The flaps provide the optimal method of revascularizing the external canal during mastoidectomy reconstructions and possibly canal defect repairs during intact canal wall mastoidectomy. Further studies are required to evaluate the efficacy of the wing flap and the MTCF.

Reconstruçäo ossicular do ouvido médio: custos versus resultados / Middle ear ossicular reconstruction: costs versus results

Os autores estudaram 92 casos de reconstruçäo da cadeia ossicular do ouvido médio e compararam seus resultados funcionais de acordo com o tipo de situaçäo criada, a técnica e o material utilizados nas reconstruçöes. Discutiram e analisaram as vantagens e desvantagens dos enxertos autógrafos e homógrafos como um todo em relaçäo aos implantes biocompatíveis na forma de "TORPS" e "PORPS", levando em conta os custos envolvidos nas duas alternativas

[Long-term anatomic results of tympanic homografts. Apropos of 170 cases]. / Résultats anatomiques à long terme des homogreffes tympaniques. A propos de 170 cas.

Long-term anatomic results of 170 tympanic homografts performed in the Necker-Enfants-Malades hospital, France between 1977 and 1983 showed high frequency of complications: early perforation (17.7%); late perforation (14%); myringitis (8.5%); recurrence of retraction (7.31%); lateralization (9.4%). These complications are of much higher frequency than after tympanoplasty with autograft, and indications for tympano-ossicular homografts are now limited to total tympanic destruction with absence of handle of malleus.

The cell-mediated response of the guinea pig's middle ear.

In this project, we studied the cell-mediated response of guinea pig's middle ear. The specific objective was to characterize rejection of skin grafts on the back (allo- and iso-grafts) after primary stimulation (iso- or allo-) in the ear or on the back. The method used was the mixed lymphocyte response with and without phytohemagglutinin (PHA). Preliminary results showed that the middle ear is able to mount a normal immune response, both locally and systemically. Such basic studies will help us to understand the otologic immune response as a whole and may shed some light on the immune phenomena observed in middle ear transplantations.

Scanning electronic microscopy of sialit-preserved total middle-ear grafts.

Twelve middle ears from human cadavers, prepared for total grafting and preserved in sialit (1:5000) for more than 10-12 months, were studied with the aid of a scanning microscope. Such investigations have not been reported before in the medical literature. The observed de-epithelialization of most of the membrane and of the ossicles and the distortion of the joints in the transmission apparatus are considered to be results of the prolonged preservation in sialit. The mesenchymal structures are well preserved an this may indicate that, after grafting, revascularization occurs along the lumina of the 'empty' vessels. Because of this finding it might be considered that the maximum duration of preservation in sialit should be no longer than 10-12 months.

[Rehabilitation of hollow cavities. 5-year evaluation]. / Réhabilitation des cavités d'évidement. Bilan de 5 années.

The Authors present the evaluation of the anatomic and functional rehabilitation of the hollow cavities from 1976 to 1981. After remembering the motives of consultation and their operating indications during the considered period, they describe their operating technique. They very often use the tympanic and banc homografts to rebuild the middle ear; but they insist above all, on the difficulties they met for the restructure of the external ear canal. Good results are observed in 47% of these cases for an one time operation. Results increase to 77% in a two time operation in their conclusion, they say that they renounced henceforth to any attempt of rehabilitation if the scooping out cavity has been realized according classical rules; but in the other cases, they still agree with such an operation but only if made in two operating phases.

[Comparison of a series of tympanic homografts alone and moulded autografts]. / Comparaison d'une série d'homogreffes de tympan seul et d'autogreffes moulées.

Anatomical and functional results were compared in a series of 60 tympanic homografts alone with those obtained after 80 moulded autografts. Anatomically, the moulded autografts were definitely superior complications of microperforations in approximately one-third of cases. However, from the functional point of veiw, homografts appear to provide better results, particular when the ossicles are intact.

Freeze-dried otologic implants.

Allograft reconstruction of the middle ear transformer mechanism is not difficult and affords a like-for-like replacement of missing parts. Allografts also afford a logical system of middle ear and external auditory canal reconstruction by providing a very similar biologic and anatomic replacement when autograft material is not available. The allograft fibrous tympanic membrane is most valuable in maintaining the accurate position of the malleus. An otologic allograft sterilized by ethylene oxide and freeze-dried is an attractive alternative to the use of chemically fixed grafts or prosthetic alloplasts. It has the inherently superior mechanical design of an allograft as well as minimum of donor tissue physiochemical alteration. Moreover, it is capable of more normal metabolc and mechanical function, a more normal histological structure, and a more normal gross anatomical appearance. In addition, it may be reliably remodeled and repaired.

Experimental and clinical immunopathology of middle ear transplantation.

On the basis of experimental data the concept of immuno-tolerance in allograft-tympanoplasty is discussed. Immunological interference in human tympanic membrane grafts has been demonstrated by means of T-cell membrane fluorescence.

Microclip application in tympanoplasty.

A new technique for attaching a tympanoplastic graft to its recipient bed is presented. One millimeter stainless steel "microclips" are used to hold the tympanic graft securely in position. Results and experience of microclip application in 404 cases are discussed.