Safety and Efficacy of Autologous Platelet-rich Fibrin on Graft Uptake in Myringoplasty: A Randomized Controlled Trial

Abstract Introduction Chronic suppurative otitis media is a common ailment in developing countries, and it generally presents with otorrhea and hearing loss. Different surgical procedures have been used to treat otitis media; among them is myringoplasty, which is a procedure that includes repair of the tympanic membrane. Platelet concentrates have been used widely in different types of wounds and are found to improve wound healing. Hence, the use of platelet-rich fibrin in myringoplasty will also improve the tympanic membrane healing. Objectives To assess the safety and efficacy of autologous platelet-rich fibrin on graft uptake in myringoplasty. Methods Eighty-six patients were observed during the study period of two years. Forty-three patients in the study group underwent myringoplasty aided with plateletrich fibrin, and 43 patients in the control group went through the same procedure but without the platelet-rich fibrin. The patients were observed for three months postoperatively by a blinded observer. Results A total of 4.7% of the patients in the study group had postoperative infection, compared with a rate of 19% in the control group (p = 0.039). The graft uptake success rate was found to be 97.7% in the study group as compared with 81% in control group (p = 0.012). The results were found to be statistically significant. Conclusion Being autologous in nature, and by comparing the groups, platelet-rich fibrin is safe for patients. The postoperative graft uptake rate is better in cases in which plateletrich fibrin was used. The postoperative infection rate was also lower in the same group. (AU)

Identification and management of inverted or everted edges of traumatic tympanic membrane perforations / Identificação e conduta nas perfurações traumáticas da membrana timpânica com bordas invertidas ou evertidas

Abstract Introduction: Most of traumatic tympanic membrane perforations have inverted or everted edges, however, the effects of inverted and everted edges on the spontaneous healing of the eardrum remain controversial. Objective: We investigated the influence of inverted or everted edges on the spontaneous healing of traumatic tympanic membrane perforations. Methods: The clinical records of patients with a traumatic tympanic membrane perforations who met the study criteria were retrieved and categorized into two groups, based on whether the eardrum was inverted or everted. The features along the edge of each inverted or everted eardrum were described using 30º and 70º endoscopes. Results: In total, 196 patients (196 ears) met the inclusion criteria; of these, 148 had inverted or everted eardrums while 48 did not. Of the 148 patients with inverted or everted eardrums, the perforation edges were everted in 77 patients, inverted in 44 patients, drooping in 17 patients, and both inverted and everted in 10 patients. The perforation shape was triangular in 18.9% of patients, sector-shaped in 11.5%, kidney-shaped in 14.2%, ovoid in 20.3%, and irregularly shaped in 35.1% of patients. The difference was not significant between the with and without inverted/everted eardrum edges groups in terms of the closure rate or closure time. Similarly, the difference was not significant between the with and without edge approximation groups in terms of the closure rate or closure time at the end of the 12-month follow-up period. Conclusion: This study suggests that endoscopic inspection can clearly identify inverted/everted eardrum edges using 30º and 70º endoscopes. The edge is glossy in inverted/everted eardrums, whereas the edge is rough and irregular in non-inverted/everted cases. The inverted/everted eardrums gradually became necrotic, but this did not affect the healing process. Additionally, edge approximation did not improve the healing outcome of traumatic tympanic membrane perforations.

Resumo Introdução: A maioria das perfurações de membrana timpânica traumáticas apresenta bordas invertidas ou evertidas; no entanto, os efeitos dessas configurações sobre a cicatrização espontânea do tímpano continuam a ser uma questão controversa. Objetivo: Investigar a influência de bordas invertidas ou evertidas sobre a cicatrização espontânea de perfurações traumáticas de membrana timpânica. Método: Os prontuários clínicos de pacientes com perfuração traumática de membrana timpânica que preencheram os critérios do estudo foram recuperados e categorizados em dois grupos, baseados na configuração invertida ou evertida das bordas da membrana timpânica. As características de configuração da borda de cada membrana foram descritas com o uso de endoscópios de 30º e 70º. Resultados: No total, 196 pacientes (196 orelhas) preencheram os critérios de inclusão; desses, 148 apresentavam bordas de membranas timpânicas invertidas ou evertidas, enquanto 48 não. Dos 148 pacientes, as bordas da perfuração estavam evertidas em 77 pacientes, invertidas em 44 pacientes, caídas em 17 pacientes e ambas invertidas e evertidas em 10 pacientes. O formato da perfuração era triangular em 18,9% dos pacientes, em forma de fatia de pizza em 11,5%, em forma de rim em 14,2%, ovoide em 20,3% e de forma irregular em 35,1% dos pacientes. A diferença não foi significante entre os grupos com e sem membrana timpânica invertida/evertida em termos de taxa ou tempo de fechamento. Da mesma forma, a diferença não foi significativa entre os grupos com e sem aproximação das bordas em termos de taxa de fechamento ou tempo de fechamento no fim do período de seguimento de 12 meses. Conclusões: Este estudo sugere que a avaliação com endoscópios de 30º e 70º pode identificar claramente as bordas invertidas/evertidas das perfurações de membranas timpânicas. A borda da perfuração timpânica em casos invertidos/evertidos é brilhante, enquanto a borda é áspera e irregular em casos não invertidos/evertidos. O rebordo timpânico invertido/evertido gradualmente torna-se necrótico, mas isso não afetou o processo de cicatrização. Além disso, a aproximação das bordas não melhorou o resultado da cicatrização.

Retrospective Analysis of 24 Cases of Forensic Medical Identification on Traumatic Tympanic Membrane Perforations / 法医学杂志

OBJECTIVES@#To study the case characteristics of forensic medical identification of traumatic tympanic membrane perforations, and to discuss the key points of forensic medical identification and evaluations methods for tympanic membrane perforations.@*METHODS@#Twenty-four cases of traumatic tympanic membrane perforations accepted by the Academy of Forensic Science during 2017 were retrospectively analysed. The data of perforation size, form, predilection site, healing time and healing mode were evaluated.@*RESULTS@#For the traumatic tympanic membrane perforations, the study showed that the small size of perforation （<1/2 quadrant） with irregular shape was common. The location of perforations was almost on the anterior and inferior quadrant, and centripetal migration healing was common. The healing rate within 6 weeks was up to 90%.@*CONCLUSIONS@#In the identification cases of traumatic tympanic membrane perforations, the key is to determine whether it is traumatic and whether it will heal spontaneously within 6 weeks. It is suggested to check the tympanic membrane weekly by an otic endoscope combined with acoustic impedance measurement at the sixth week, which can improve the accuracy, objectivity and scientificity of the identification.

Acido tricloroacético como tratamiento en la perforación de la membrana timpánica / Trichloroacetic acid as treatment for tympanic membrane perforation

OBJETIVO: Determinar la frecuencia de curación de la perforación de la membrana timpánica con la aplicación de Acido Tricloroacético al 50. MATERIAL Y MÉTODOS: estudio de serie de casos, el universo fue 21 pacientes, a los que se les aplicó ácidotricloroacético al 50 sobre el margen de la perforación timpánica, previo a la aplicación se realizó una escarificación. Los pacientes se controlaron cada 2 semanas para evaluar resultados. Se consideró como curado el cierre de la perforación. RESULTADOS: en 10 (48) pacientes se obtuvo curación de la perforación, en siete de estos se necesitó de una a cuatro sesiones de tratamiento. CONCLUSIONES: En casi la mitad de los casos, las perforaciones Grado I y II de la membrana timpánica responden favorablemente con el manejo conservador mediante la aplicación de ácido...

Blast injury of the ears: the experience from Yala Hospital, Southern Thailand.

OBJECTIVE: To report acute and subacute consequences of blast injury to the ear from terrorists' bombings experienced from Yala Provincial Hospital, Southern Thailand STUDY DESIGN: Retrospective chart review was done on 54 patients who suffered otologic injuries from bombing attacks in Yala Province from January to May 2005. Only 33 patients who had complete otologic and audiologic examination with a 3-month follow-up were studied. MATERIAL AND METHOD: The ear symptoms, the size of tympanic membrane perforation, degree of hearing loss at first examination within 30 days after injuries were recorded. After a 3-month follow-up, the rate of spontaneous healing, rate of operation needed and long-term complications including hearing loss were analyzed. RESULTS: The two most common initial symptoms were hearing loss (72.73%) and tinnitus (66.67%). Tympanic membrane perforations were encountered in 31 ears of 22 out of 33 patients. Spontaneous healing occurred in 23 ears (74.19%) with the highest incidence in small perforations (size < 50%). All healings occurred within 8 weeks. Tympanoplasty was done on the rest, except one patient. Eight patients (24.24%) had sensorineural hearing loss without tympanic membrane perforation. They still have sensorineural hearing loss, which is rather mild and typically affects in high tone with five of this group having normal hearing in speech range. Eleven patients from the tympanic membrane perforation group still have mixed hearing loss, which were also mostly mild. CONCLUSION: Patients with aural symptoms after a blast injury need thorough otologic and audiological examination. The spontaneous healing of tympanic membrane perforation from explosive injury was relatively high (74.19%) after an 8-week follow-up, only 8/31 ears required surgical repair. At 3-months follow-up, more than two-thirds of the patients still had residual hearing loss, which was rather mild and affected mainly in high tone.

Comportamento otoscópico e timpanométrico em indivíduos realizando mergulho autônomo recreacional de repetição / Otoscopic and tympanometric behavior in repeated recreational divers

Objetivamos com este estudo observacional avaliar como se comportam os resultados timpanométricos e otoscópicos das membranas timpânicas de mergulhadores recreacionais submetidos a mergulhos de repetição. Nossa casuística do presente estudo é composta de 19 mergulhadores autônomos recreacionais submetidos a quatro mergulhos de repetição. As variáveis estudadas no trabalho foram os achados otoscópicos e os achados Timpanométricos, todos estes imediatamente antes e após cada mergulho. Nossos achados sugerem que a prática de mergulhos de repetição no mesmo dia, situação comum em populações embarcadas para a prática do mergulho autônomo recreacional, produzem uma piora progressiva dos resultados timpanométricos e do aspecto otoscópico das membranas /The objective of the present observational study was to assess the tympanometric and otoscopic findings observed in the tympanic membranes of recreational divers submitted to repeated diving. The study was conducted on 19 autonomous recreational divers submitted to 4 daily repetition dives on 5 consecutive days. The findings suggest that the practice of repeated recreational autonomous diving causes a progressive worsening of the tympanometric results and of the otoscopic aspect of the tympanic membranes...

Paresia bilateral assimétrica de nervo troclear associada a trombose de seio transverso pós-otite: relato de caso / Asymmetric bilateral paresia of trochlear nerv associated the post-otitis transverse sinus thrombosis: case report

Os autores descrevem um caso de otite média aguda pós-perfuraçäo de membrana timpânica, que evoluiu com trombose de seio transverso esquerdo, paresia facial central à direita e paresia troclear bilateral assimétrica. O exame oftalmológico mostrou hipofunçäo do OS e hiperfunçäo do OI nos dois olhos, mais intensas no olho direito. O sinal de Bielchowsky era positivo à direita e negativo à esquerda. A acuidade visual estava preservada, além de ausência de papiledema à fundoscopia. A arteriografia cerebral revelou unicamente trombose do seio transverso à esquerda. O tratamento institui do foi antibioticoterapia via oral e cumarínico. Após seis meses de evoluçäo a diplopia persistia apenas em infralevoversäo, porém persistia a paresia facial central à direita. Näo se encontrou na literatura relato semelhante ao descrito.

Analysis on characters of 220 cases of tympani membrane perforated / 法医学杂志

220 cases of tympani membrane perforated were summarized retrospectively. The tympani membrane perforated of injury was different from otitis media's because they had marked or extreme marked difference in sex, age, ear distinction, shape, position, size, degree of hearing damaged, time of healing, cause of perforating and adhesive substance. This difference was relative to mechanism of tympani membrane perforated. The distinction gist of two sorts of tympani membrane perforated was expounded through comparison and analysis. It would be of great value to clinical forensic medical examination.