The Effectiveness of bFGF in the Treatment of Tympanic Membrane Perforations: A Systematic Review and Meta-Analysis.

OBJECTIVE: To investigate the effectiveness of basic fibroblast growth factor (bFGF) versus placebo or no intervention in the treatment of tympanic membrane (TM) perforations from randomized controlled trials (RCTs), prospective and retrospective studies. DATA SOURCES: PubMed, EMBASE, and Cochrane databases were screened from their inceptions to June 2019. STUDY SELECTION: Inclusion criteria: 1) English language; 2) observational (retrospective or prospective) or treatment (RCT) studies; 3) reported the outcomes on the application of bFGF in adult or pediatric population. EXCLUSION CRITERIA: 1) studies without a control group; 2) animal studies, in vitro studies, review studies, and case reports. DATA EXTRACTION: Number of patients, cause of TM perforation, perforation size, treatment, mean age, follow-up time, sex, closure rate, healing time, mean air-bone gap improvement. DATA SYNTHESIS: A total of 14 studies were included, including seven RCTs and seven non-RCTs with a total of 1,072 participants. The odds ratio for closure rate of bFGF treatment was 7.33 (95% confidence interval [CI], 4.65 to 11.53; p < 0.01; I = 44%) and the standardized mean difference (SMD) for healing time was -5.89 (95% CI: -7.85 to -3.93, p < 0.01, I = 98%), suggesting bFGF application has a significant effect on closure of TM perforations. However, no significant change in hearing (SMD: 0.08, 95% CI: -0.11 to 0.27, p = 0.39, I = 0%) was seen as a result of bFGF treatment. CONCLUSIONS: Our meta-analysis has revealed that the application of bFGF can significantly enhance the closure rate as well as shorten the healing time for TM perforations. In terms of hearing, there is as yet no evidence that bFGF has a significant effect. Given its ease, availability, and safety, bFGF can be used effectively for TM repair.

Optical Coherence Tomography of the Tympanic Membrane and Middle Ear: A Review.

Objective To evaluate the recent developments in optical coherence tomography (OCT) for tympanic membrane (TM) and middle ear (ME) imaging and to identify what further development is required for the technology to be integrated into common clinical use. Data Sources PubMed, Embase, Google Scholar, Scopus, and Web of Science. Review Methods A comprehensive literature search was performed for English language articles published from January 1966 to January 2018 with the keywords "tympanic membrane or middle ear,""optical coherence tomography," and "imaging." Conclusion Conventional imaging techniques cannot adequately resolve the microscale features of TM and ME, sometimes necessitating diagnostic exploratory surgery in challenging otologic pathology. As a high-resolution noninvasive imaging technique, OCT offers promise as a diagnostic aid for otologic conditions, such as otitis media, cholesteatoma, and conductive hearing loss. Using OCT vibrometry to image the nanoscale vibrations of the TM and ME as they conduct acoustic waves may detect the location of ossicular chain dysfunction and differentiate between stapes fixation and incus-stapes discontinuity. The capacity of OCT to image depth and thickness at high resolution allows 3-dimensional volumetric reconstruction of the ME and has potential use for reconstructive tympanoplasty planning and the follow-up of ossicular prostheses. Implications for Practice To achieve common clinical use beyond these initial discoveries, future in vivo imaging devices must feature low-cost probe or endoscopic designs and faster imaging speeds and demonstrate superior diagnostic utility to computed tomography and magnetic resonance imaging. While such technology has been available for OCT, its translation requires focused development through a close collaboration between engineers and clinicians.

Affordable headphones for accessible screening audiometry: An evaluation of the Sennheiser HD202 II supra-aural headphone.

OBJECTIVE: Evaluation of the Sennheiser HD 202 II supra-aural headphones as an alternative headphone to enable more affordable hearing screening. DESIGN: Study 1 measured the equivalent threshold sound pressure levels (ETSPL) of the Sennheiser HD 202 II. Study 2 evaluated the attenuation of the headphones. Study 3 determined headphone characteristics by analyzing the total harmonic distortion (THD), frequency response and force of the headband. STUDY SAMPLE: Twenty-five participants were included in study 1 and 15 in study 2 with ages ranging between 18 and 25. No participants were involved in study 3. RESULTS: The Sennheiser HD 202 II ETSPLs (250-16000 Hz) showed no significant effects on ETSPL for ear laterality, gender or age. Attenuation was not significantly different (p > 0.01) to TDH 39 except at 8000 Hz (p < 0.01). Maximum permissible ambient noise levels (MPANL) were specified accordingly. The force of the headband was 3.1N. THD measurements showed that between 500 and 8000 Hz intensities of 90 dB HL and higher can be reached without THD >3%. CONCLUSION: Sennheiser HD 202 II supra-aural headphones can be used as an affordable headphone for screening audiometry provided reported MPANLs, maximum intensities and ETSPL values are employed.

Type I Tympanoplasty Meta-Analysis: A Single Variable Analysis.

OBJECTIVE: To determine which independent variables influence the efficacy of type I tympanoplasty in adult and pediatric populations. DATA SOURCES: A search of the PubMed database and Cochrane Database of Systematic Reviews using the key words "tympanoplasty OR myringoplasty" from January 1966 to July 2014 was performed. STUDY SELECTION: Studies reporting outcomes of myringoplasty or Type I tympanoplasty in primary non-cholesteatomatous chronic tympanic membrane (TM) perforation were included. DATA EXTRACTION: Of 4,698 abstracts reviewed, 214 studies involving 26,097 patients met our inclusion criteria and contributed to meta-analysis. DATA SYNTHESIS: The primary outcome of success was defined as closure rate at 12 months. The independent variables analyzed were age, follow-up period, approach, graft material, perforation cause, size, location, ear dryness, and surgical technique. Only those studies providing data on a given parameter of interest could be included when comparing each variable. CONCLUSION: The weighted average success rate of tympanic closure was 86.6%. Based on this meta-analysis, pediatric surgery has a 5.8% higher failure rate than adults and there is no correlation between follow-up period and success. Other variables associated with improved closure rates include perforation with a size less than 50% of total area (improved by 6.1%) and the use of cartilage as a graft (improved by 2.8% compared with fascia), while ears that were operated on while still discharging, those in different locations of the pars tensa, or using different surgical approaches or techniques did not have significantly different outcomes.

Scaffolds for tympanic membrane regeneration in rats.

Tympanic membrane (TM) perforations lead to significant hearing loss and result in possible infection of the middle ear. Myringoplasty is commonly performed to repair chronic perforations. Although various grafts and materials have been used to promote TM regeneration, all have associated limitations. The aim of this study was to evaluate the efficacy and feasibility of two graft materials, silk fibroin scaffold (SFS) and porcine-derived acellular collagen type I/III scaffold (ACS), compared with two commonly used graft materials (paper patch and Gelfoam) for the promotion of TM regeneration. These scaffolds were implanted using on-lay myringoplasty in an acute TM perforation rat model. Surface morphology of the scaffolds was observed with scanning electron microscopy. The morphology of the TM was assessed at various time points postimplantation using otoscopy, light and electron microscopy, and functional outcomes by auditory brainstem responses. We found that SFS and ACS significantly accelerated the TM perforation closure, obtained optimal TM thickness, and resulted in better trilaminar morphology with well-organized collagen fibers and early restoration of hearing. However, paper patch and Gelfoam lost their scaffold function in the early stages and showed an inflammatory response, which may have contributed to delayed healing. This study indicates that compared with paper patch and Gelfoam, SFS and ACS are more effective in promoting an early TM regeneration and an improved hearing, suggesting that these scaffolds may be potential substitutes for clinical use.

Mobile and landline telephone performance outcomes among telephone-using cochlear implant recipients.

OBJECTIVE: To objectively study mobile and standard landline telephone speech perception performance using cochlear implant recipients. STUDY DESIGN: Nonrandomized trial. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Twenty-five subjects enrolled in this study from a pool of 50 cochlear implant recipients who had participated in an earlier questionnaire study from which demographic data were gathered. Preoperative speech perception scores were collated from preoperative audiological data. Postoperative speech perception scores were calculated with subjects listening to the Australian Version of the Bamford-Kowal-Bench Sentence Test read aloud in a soundproof booth via live voice, played back on a speaker, on a standard landline and mobile phone. Telephone speech perception scores were analyzed and banded into 3 performance categories: very good (90%-100%), good (80%-89%), and fair (<80%). RESULTS: The mean speech perception scores were 88.6% (SD, 14.3%) for postoperative recorded speech and 92.3% (SD, 10.7%) for live voice listening, which were significantly better than the mean score of 37.2% (SD, 29.1%) listening to recorded voice preoperatively. The mean speech perception score was 84.3% (SD, 20.7%) using a mobile telephone and 57% (SD, 29.4%) using the standard landline. Further analysis showed better performance with mobile phones over standard landlines. Seventy-six percent of subjects attained at least good telephone speech performance (score >80%). Older patients had poorer telephone speech perception than younger patients did. CONCLUSIONS: Many cochlear implant recipients achieve good objective telephone speech perception performance, indicating that they should be effective telephone users, especially when using mobile telephones and among younger implant recipients.

To pack or not to pack? A contemporary review of middle ear packing agents.

Middle ear packing agents are used in otologic surgery to provide support to the middle ear structures, maintain aeration of the middle ear, and promote hemostasis. However, there is currently a lack of standardization regarding the use of different types of packing agents. The choice of materials and how they are used remain controversial. In fact, some have recently advocated for no packing. In view of this, this review focuses on the types of materials available, a brief historical account of each material, characteristics of an ideal packing agent, and a discussion on the techniques of insertion to optimize surgical outcomes.

Preliminary results of the application of a silk fibroin scaffold to otology.

The surgical treatment to repair chronic tympanic membrane perforations is myringoplasty. Although multiple autologous grafts, allografts, and synthetic graft materials have been used over the years, no single graft material is superior for repairing all perforation types. Recently, the remarkable properties of silk fibroin protein have been studied, with biomedical and tissue engineering applications in mind, across a number of medical and surgical disciplines. The present study examines the use of silk fibroin for its potential suitability as an alternative graft in myringoplasty surgery by investigating the growth and proliferation of human tympanic membrane keratinocytes on a silk fibroin scaffold in vitro. Light microscopy, immunofluorescent staining, and confocal imaging all reveal promising preliminary results. The biocompatibility, transparency, stability, high tensile strength, and biodegradability of fibroin make this biomaterial an attractive option to study for this utility.