Repair of large traumatic tympanic membrane perforation using ofloxacin otic solution and gelatin sponge.

INTRODUCTION: Traumatic large tympanic membrane perforations usually fail to heal and require longer healing times. Few studies have compared the healing and hearing outcomes between gelatin sponge patching and ofloxacin otic solution. OBJECTIVES: To compare the healing outcomes of large traumatic tympanic membrane perforations treated with gelatin sponge, ofloxacin otic solution, and spontaneous healing. METHODS: Traumatic tympanic membrane perforations >50% of the entire eardrum were randomly divided into three groups: ofloxacin otic solution, gelatin sponge patch and spontaneous healing groups. The healing outcome and hearing gain were compared between the three groups at 6 months. RESULTS: A total of 136 patients with large traumatic tympanic membrane perforations were included in analyses. The closure rates were 97.6% (40/41), 87.2% (41/47), and 79.2% (38/48) in the ofloxacin otic solution, gelatin sponge patch, and spontaneous healing groups, respectively (p=0.041). The mean times to closure were 13.12±4.61, 16.47±6.24, and 49.51±18.22 days in these groups, respectively (p<0.001). CONCLUSIONS: Gelatin sponge patch and ofloxacin otic solution may serve as effective and inexpensive treatment strategies for traumatic large tympanic membrane perforations. However, ofloxacin otic solution must be self-applied daily to keep the perforation edge moist, while gelatin sponge patching requires periodic removal and re-patching.

The effect of epidermal growth factor on the pseudo-healing of traumatic tympanic membrane perforations / Efeito do fator de crescimento epidérmico na pseudocicatrização de perfurações traumáticas da membrana timpânica

Abstract Introduction: Traumatic tympanic membrane perforations tend to heal spontaneously. However, in this study, several perforations exhibited abnormal healing, where the morphology of healing tympanic membranes differed from that of non-perforated tympanic membranes. Pseudo-healing of the tympanic membrane was characterized by the accumulation of thickened tissue in the perforated area. Objective: The purpose of this study was to evaluate the utility of epidermal growth factor in cases showing pseudo-healing of traumatic tympanic membrane perforations. Methods: A total of 26 traumatic tympanic membrane perforations showing pseudo-healing were included in this study. In all cases, tissue that accumulated in the perforated area was removed, which subsequently caused a new perforation to form. An epidermal growth factor solution was applied to the tympanic membrane once daily to keep the tympanic membrane moist. Closure rates and times were evaluated at 6 months. Results: During the 6 months follow-up period, two patients were lost. Of the remaining 24 patients, the closure rate was 100% (24/24) and the closure time was 6.1 ± 2.3 days (range: 3-12 days). The morphology of the healed tympanic membrane was not significantly different from that of the remnant tympanic membrane. Conclusions: Pseudo-healing of traumatic tympanic membrane perforations affects sound conduction. This can be associated with various symptoms, including tinnitus, aural fullness, and ear discomfort. The excision of excessive epithelial tissue and topical application of epidermal growth factor can correct the pseudo-healing of traumatic tympanic membrane perforations.

Resumo Introdução: As perfurações traumáticas da membrana timpânica tendem a cicatrizar espontaneamente. Entretanto, neste estudo, várias perfurações exibiram cicatrização anormal, na qual a morfologia da cicatrização das membranas timpânicas diferiu da de membranas timpânicas não perfuradas. A pseudocicatrização da membrana timpânica foi caracterizada pelo acúmulo de tecido espesso na área perfurada. Objetivo: Avaliar a utilidade do fator de crescimento epidérmico em casos que apresentaram pseudocicatrização de perfurações traumáticas da membrana timpânica. Método: Um total de 26 casos de perfurações traumáticas da membrana timpânica apresentando pseudocicatrização foram incluídos neste estudo.. Em todos os casos, o tecido que se acumulou na área perfurada foi removido, o que subsequentemente causou uma nova perfuração. Uma solução de fator de crescimento epidérmico foi aplicada à membrana timpânica uma vez ao dia para manter a membrana timpânica úmida. As taxas de fechamento e os tempos foram avaliados aos 6 meses. Resultados: Dois pacientes foram perdidos no período de 6 meses de acompanhamento. Dos 24 pacientes restantes, a taxa de fechamento foi de 100% (24/24) e o tempo de fechamento foi de 6,1 ± 2,3 dias (variação: 3 a 12 dias). A morfologia da membrana timpânica cicatrizada não foi significativamente diferente daquela da membrana timpânica remanescente. Conclusões: A pseudocicatrização de perfurações traumáticas da membrana timpânica afeta a condução do som. Isso pode estar associado a vários sintomas, inclusive zumbido, plenitude aural e desconforto auditivo. A excisão do tecido epitelial excessivo e a aplicação tópica de fator de crescimento epidérmico podem corrigir a pseudocicatrização de perfurações traumáticas da membrana timpânica.

The effect of epidermal growth factor on the pseudo-healing of traumatic tympanic membrane perforations.

INTRODUCTION: Traumatic tympanic membrane perforations tend to heal spontaneously. However, in this study, several perforations exhibited abnormal healing, where the morphology of healing tympanic membranes differed from that of non-perforated tympanic membranes. Pseudo-healing of the tympanic membrane was characterized by the accumulation of thickened tissue in the perforated area. OBJECTIVE: The purpose of this study was to evaluate the utility of epidermal growth factor in cases showing pseudo-healing of traumatic tympanic membrane perforations. METHODS: A total of 26 traumatic tympanic membrane perforations showing pseudo-healing were included in this study. In all cases, tissue that accumulated in the perforated area was removed, which subsequently caused a new perforation to form. An epidermal growth factor solution was applied to the tympanic membrane once daily to keep the tympanic membrane moist. Closure rates and times were evaluated at 6 months. RESULTS: During the 6 months follow-up period, two patients were lost. Of the remaining 24 patients, the closure rate was 100% (24/24) and the closure time was 6.1 ±â€¯2.3 days (range: 3-12 days). The morphology of the healed tympanic membrane was not significantly different from that of the remnant tympanic membrane. CONCLUSIONS: Pseudo-healing of traumatic tympanic membrane perforations affects sound conduction. This can be associated with various symptoms, including tinnitus, aural fullness, and ear discomfort. The excision of excessive epithelial tissue and topical application of epidermal growth factor can correct the pseudo-healing of traumatic tympanic membrane perforations.

Efecto del factor de crecimiento endotelio vascular (VEGF) sobre perforaciones timpánicas en ratas Long-Evans / Effect of vascular endothelial growth factor (VEGF) on tympanic perforations in Long-Evans rats

Introducción: La anglogenesis es el desarrollo de nuevos vasos sanguíneos desde una red vascular existente, contempla una secuencia de eventos complejos y es fundamental en el proceso reparativo. Existen múltiples factores estimulantes de la angiogénesls, entre ellos se encuentran factores de crecimiento como el VEGF (factor de crecimiento endotelio vascular). Debido a su rol reparativo se han utilizado factores proanglogénicos para reparar perforaciones timpánicas. Objetivo: Estudiar el efecto del VEGF sobre perforaciones timpánicas de ratas Long-Evans. Material y método: Se usan 15 ratas adultas, se realizan perforaciones timpánicas bilaterales, se instilan al azar las perforaciones con solución fisiológica y VEGF, se realiza visualización microscópica de los tímpanos a los días 9,15 y 21 posperforación. Las ratas son sacrificadas el día 21 y se realiza estudio histológico del grosor timpánico. Resultados: No se aprecia un efecto inductivo del VEGF sobre el cierre de las perforaciones timpánicas, se produce un aumento en el grosor timpánico de las ratas tratadas con VEGF.

Healing of subacute tympanic membrane perforations in chinchillas treated with epidermal growth factor and pentoxifylline.

HYPOTHESIS: The aims of the present study were to determine the effect of epidermal growth factor (EGF) and pentoxifylline on subacute tympanic membrane (TM) perforations and to quantify the healing rate of such perforations treated with these drugs alone or in combination. BACKGROUND: It is known that EGF modulates in vitro and in vivo proliferation of epithelial and endothelial cells. Pentoxifylline is a methylxanthine that has been used to treat experimental skin flaps and venous leg ulcers. Data in the literature regarding this subject are contradictory, and quantitative data regarding the effects of EGF and pentoxifylline on TM perforation healing are scarce. METHODS: We studied 50 chinchillas submitted to TM perforation. On postoperative Day 30, eight were selected for histologic analysis. Of the remaining 42, those presenting little or no healing were distributed into four groups: control, EGF, pentoxifylline, and EGF combined with pentoxifylline. RESULTS: Histologic analysis showed that the observation period adopted was sufficient to consider the TM perforations subacute. We found significant differences between the study groups and the control group in the healing rate of subacute TM perforations during a 30-day period (analysis of variance; p < 0.001), which was 30.3% for the EGF group, 3.6% for the pentoxifylline group, 16.5% for the EGF-pentoxifylline group, and 8.7% for the control group. CONCLUSIONS: The use of EGF promoted healing of subacute TM perforations in chinchillas, and the use of pentoxifylline did not. The combination of the two had no synergistic effect on the healing of these perforations.

Otitis media aguda / Acute otitis media

La otitis media aguda (OMA) es la infección bacteriana más frecuente de la infancia, causada principalmente por streptococcus pneumoniae (40 por ciento), haemophilus influenzae (25 por ciento) y moraxella catarrhalis (10 por ciento) y precedida por infecciones virales respiratorias en aproximadamente 70 por ciento de los casos. La OMA es una infección de buen pronóstico con una tasa de mejoría espontánea cercana a 80 por ciento; sin embargo, los antibióticos son ampliamente usados en su tratamiento constituyendo la principal indicación de amtimicrobianos orales en la infancia. La evidencia acumulada de que el beneficio del tratamiento antibiótico es pobre, apunta a que ni el tipo ni el tiempo de tratamiento antibacteriano influyen sobre los resultados finales. Por otra parte, el uso rutinario y por tiempo prolongado de antimicrobiano contribuye al desarrollo de cepas resistentes aumentando el riesgo de portación faríngea y su rápida diseminación. No ha sido demostrado que el uso rutinario de antibióticos en el tratamiento de la OMA sea más efectivo que el uso selectivo para evitar sus complicaciones. Estudios clínicos demuestran la esterilización del fluido del oído medio entre el tercero y sexto día de tratamiento. Una buena correlación entre la mejoría bacteriológica y clínica apoya la hipótesis que un régimen de tratamiento de 3 a 6 días serían tan eficiente como uno de 10. Sin embargo, la tasa de erradicación en los lactantes es menor observádose en ellos mayores fracasos terapéuticos. Un meta-analisis de 32 trabajos controlados y randomizados que compara los resultados de diversos esquemas terapéuticos, indicados por menos de 7 días o más, revela que los resultados evaluados a los 30 días son comparables (OR 1.22) siendo la diferencia en el riesgo de fracaso de 2.3 por ciento. Expresado en NNT (número necesario tratar), 44 niños requieren ser tratados con el tratamiento convencional para evitar un fracaso terapéutico con el esquema acortado. La perspectiva de éxito de un tratamiento acortado en pacientes con OMA no complicada es bastante alta, sin embargo, se requiere mayores estudios para avalar su uso en lactantes