Skip to main content
×
Home

A moist edge environment aids the regeneration of traumatic tympanic membrane perforations

  • Z C Lou (a1) and Z H Lou (a2)
Abstract
Abstract Objective:

To review the history of moist therapy used to regenerate traumatic tympanic membrane perforations.

Study design:

Literature review.

Methods:

The literature on topical agents used to treat traumatic tympanic membrane perforations was reviewed, and the advantages and disadvantages of moist therapy were analysed.

Results:

A total of 76 studies were included in the analysis. Topical applications of certain agents (e.g. growth factors, Ofloxacin Otic Solution, and insulin solutions) to the moist edges of traumatic tympanic membrane perforations shortened closure times and improved closure rates.

Conclusion:

Dry tympanic membrane perforation edges may be associated with crust formation and centrifugal migration, delaying perforation closure. On the contrary, moist edges inhibit necrosis at the perforation margins, stimulate proliferation of granulation tissue and aid eardrum healing. Thus, moist perforation margins upon topical application of solutions of appropriate agents aid the regeneration of traumatic tympanic membrane perforations.

Copyright
Corresponding author
Address for correspondence: Dr Zhengcai Lou, Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University, 699 Jiangdong Road, Yiwu, Zhejiang 322000, China Fax: +86 0579 520 9678 E-mail: louzhengcai@163.com
References
Hide All
1 Griffin WL Jr. A retrospective study of traumatic tympanic membrane perforations in a clinical practice. Laryngoscope 1979;89:261–82
2 Ott MC, Lundy LB. Tympanic membrane perforation in adults: how to manage, when to refer. Postgrad Med 2001;110:81–4
3 Toner JG, Kerr AG. Chapter 7: Ear trauma. In: Kerr AG, ed. Scott-Brown's Otolaryngology, Volume 3, 6th edn. Oxford: Butterworth-Heinemann, 1997;13
4 Orji FT, Agu CC. Determinants of spontaneous healing in traumatic perforations of the tympanic membrane. Clin Otolaryngol 2008;33:420–6
5 Gladstone HB, Jackler RK, Varav K. Tympanic membrane wound healing. An overview. Otolaryngol Clin North Am 1995;28:913–32
6 Fina M, Baird A, Ryan A. Direct application of basic fibroblast growth factor improves tympanic membrane perforation healing. Laryngoscope 1993;103:804–9
7 Chauvin K, Bratton C, Parkins C. Healing large tympanic membrane perforations using hyaluronic acid, basic fibroblast growth factor, and epidermal growth factor. Otolaryngol Head Neck Surg 1999;121:43–7
8 Lou Z, Yang J, Tang Y, Xiao J. Risk factors affecting human traumatic tympanic membrane perforation regeneration therapy using fibroblast growth factor-2. Growth Factors 2015;33:410–18
9 von Unge M, Dirckx JJ, Olivius NP. Embryonic stem cells enhance the healing of tympanic membrane perforations. Int J Pediatr Otorhinolaryngol 2003;67:215–19
10 Fina M, Bresnick S, Baird A, Ryan A. Improved healing of tympanic membrane perforations with basic fibroblast growth factor. Growth Factors 1991;5:265–72
11 Mondain M, Saffiedine S, Uziel A. Fibroblast growth factor improves the healing of experimental tympanic membrane perforations. Acta Otolaryngol 1991;111:337–41
12 Vrabec JT, Schwaber MK, Davidson JM, Clymer MA. Evaluation of basic fibroblast growth factor in tympanic membrane repair. Laryngoscope 1994;104:1059–64
13 Araujo MM, Murashima AA, Alves VM, Jamur MC, Hyppolito MA. The topical use of insulin accelerates the healing of traumatic tympanic membrane perforations. Laryngoscope 2016;126:156–62
14 Lou Z, Lou Z, Tang Y, Xiao J. The effect of ofloxacin otic drops on the regeneration of human traumatic tympanic membrane perforations. Clin Otolaryngol 2016;41:564–70
15 Yang J, Lou Z-H, Fu Y, Zheng C-L. A retrospective study of EGF and ofloxacin drops in the healing of human large traumatic eardrum perforation. Am J Otolaryngol 2016;37:294–8
16 Yamazaki K, Ishijima K, Sato H. A clinical study of traumatic tympanic membrane perforation [in Japanese]. Nihon Jibiinkoka Gakkai Kaiho 2010;113:679–86
17 Lou ZC, Lou ZH, Liu YC, Chang J. Healing human moderate and large traumatic tympanic membrane perforations using basic fibroblast growth factor, 0.3% ofloxacin eardrops, and gelfoam patching. Otol Neurotol 2016;37:735–41
18 Buyten J, Kaufman G, Ryan M. Effects of ciprofloxacin/dexamethasone and ofloxacin on tympanic membrane perforation healing. Otol Neurotol 2007;28:887–90
19 Amadasun JE. An observational study of the management of traumatic tympanic membrane perforations. J Laryngol Otol 2002;116:181–4
20 Akkoc A, Celik H, Arslan N, Demirci S, Hucumenoglu S, Caydere M et al. The effects of different environmental pH on healing of tympanic membrane: an experimental study. Eur Arch Otorhinolaryngol 2016;273:2503–8
21 Onal K, Uguz MZ, Kazikdas KC, Gursoy ST, Gokce H. A multivariate analysis of otological, surgical and patient-related factors in determining success in myringoplasty. Clin Otolaryngol 2005;30:115–20
22 Santosh UP, Prashanth KB, Rao MS. Study of myringoplasty in wet and dry ears in mucosal type of chronic otitis media. J Clin Diagn Res 2016;10:MC01–03
23 Shankar R, Virk RS, Gupta K, Gupta AK, Bal A, Bansal S. Evaluation and comparison of type I tympanoplasty efficacy and histopathological changes to the tympanic membrane in dry and wet ears: a prospective study. J Laryngol Otol 2015;129:945–9
24 Tan HE, Santa Maria PL, Eikelboom RH, Anandacoomaraswamy KS, Atlas MD. Type I tympanoplasty meta-analysis: a single-variable analysis. Otol Neurotol 2016;37:838–46
25 Sckolnick JS, Mantle B, Li J, Chi DH. Pediatric myringoplasty: factors that affect success--a retrospective study. Laryngoscope 2008;118:723–9
26 Albera R, Ferrero V, Lacilla M, Canale A. Tympanic reperforation in myringoplasty: evaluation of prognostic factors. Ann Otol Rhinol Laryngol 2006;115:875–9
27 Adkins WY, White B. Type I tympanoplasty: influencing factors. Laryngoscope 1984;94:916–18
28 Vartiainen E, Kärjä J, Karjalainen S, Härmä R. Failures in myringoplasty. Arch Otorhinolaryngol 1985;242:2733
29 Vijayendra H, Rangam CK, Sangeeta R. Comparative study of tympanoplasty in wet perforation v/s totally dry perforation in tubotympanic disease. Indian J Otolaryngol Head Neck Surg 2006;58:165–7
30 Odland GF. The fine structure of the interrelationship of cells in the human epidermis. J Biophys Biochem Cytol 1958;4:529–38
31 Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 1962;193:293–4
32 Hinman CD, Maibach H. Effect of air exposure and occlusion on experimental human skin wounds. Nature 1963;200:377–8
33 Zahir M. Effect of scabs on the rate of epidermal regeneration in the skin wounds of guinea pigs. Nature 1963;199:1013–14
34 Rovee DT, Kurowsky CA, Labun J. Local wound environment and epidermal healing: mitotic response. Arch Dermatol 1972;106:330–4
35 Alvarez OM, Mertz PM, Eaglstein WH. The effect of occlusive dressings on collagen synthesis and re-epithelialisation in superficial wounds. J Surg Res 1983;35:142–8
36 Eaglstein WH, Davis SC, Mehle AL, Mertz PM. Optimal use of an occlusive dressing to enhance healing: effect of delayed application and early removal on wound healing. Arch Dermatol 1988;124:392–5
37 Schultz GS, Sibbald RG, Falanga V, Ayello EA, Dowsett C, Harding K et al. Wound bed preparation: a systematic approach to wound management. Wound Repair Regen 2003;11:128
38 Dowsett C, Ayello E. TIME principles of chronic wound bed preparation and treatment. Br J Nurs 2004;13:S1623
39 Okan D, Woo K, Ayello EA, Sibbald G. The role of moisture balance in wound healing. Adv Skin Wound Care 2007;20:3953
40 Schultz G, Mast B. Molecular analysis of the environment of healing and chronic wounds: cytokines, proteases and growth factors. Wounds 1998;10:19F
41 Mast BA, Schultz GS. Interactions of cytokines, growth factors, and proteases in acute and chronic wounds. Wound Repair Regen 1996;4:411–20
42 Kloth LC. Electrical stimulation for wound healing: a review of evidence from in vitro studies, animal experiments, and clinical trials. Int J Low Extrem Wounds 2005;4:2344
43 Svensjö T, Pomahac B, Yao F, Slama J, Eriksson E. Accelerated healing of full-thickness skin wounds in a wet environment. Plast Reconstr Surg 2000;106:602–14
44 Vogt PM, Andree C, Breuing K, Liu PY, Slama J, Helo G et al. Dry, moist and wet skin wound repair. Ann Plast Surg 1995;34:493–9, discussion 499–500
45 Dunlap AM, Schuknecht HF. Closure of perforations of the tympanic membrane. Laryngoscope 1947;57:479–90
46 Miyoshi M, Kawazoe T, Igawa HH, Tabata Y, Ikada Y, Suzuki S. Effects of bFGF incorporated into a gelatin sheet on wound healing. J Biomater Sci Polym Ed 2005;16:893907
47 Yan L, Wu W, Wang Z, Li C, Lu X, Duan H et al. Comparative study of the effects of recombinant human epidermal growth factor and basic fibroblast growth factor on corneal epithelial wound healing and neovascularization in vivo and in vitro. Ophthalmic Res 2013;49:150–60
48 Kamo K, Miyakoshi N, Kasukawa Y, Sasaki H, Shimada Y. Effects of single and cyclical local injections of basic fibroblast growth factor on cancellous bone defects in rabbits. J Orthop Sci 2009;14:811–19
49 Mondain M, Ryan A. Epidermal growth factor and basic fibroblast growth factor are induced in guinea pig tympanic membrane following traumatic perforation. Acta Otolaryngol 1995;115:50–4
50 Mondain M, Ryan A. Histological study of the healing of traumatic tympanic membrane perforation after basic fibroblast growth factor application. Laryngoscope 1993;103:312–18
51 Ishimoto S, Ishibashi T, Bottaro DP, Kaga K. Direct application of keratinocyte growth factor, basic fibroblast growth factor and transforming growth factor-alpha during healing of tympanic membrane perforation in glucocorticoid-treated rats. Acta Otolaryngol 2002;122:468–73
52 Wang WQ, Wang ZM, Chi FL. Spontaneous healing of various tympanic membrane perforations in the rat. Acta Otolaryngol 2004;124:1141–4
53 Araújo MM, Murashima AA, Alves VM, Jamur MC, Hyppolito MA. Spontaneous healing of the tympanic membrane after traumatic perforation in rats. Braz J Otorhinolaryngol 2014;80:330–8
54 Makino K, Amatsu M, Kinishi M, Mohri M. Epithelial migration in the healing process of tympanic membrane perforations. Eur Arch Otorhinolaryngol 1990;247:352–5
55 Taylor M, McMinn RM. Cytology of repair in experimental perforation of the tympanic membrane and its relationship to chronic perforations in man. Trans Am Acad Ophthalmol Otolaryngol 1967;71:802–12
56 Martini A, Govoni E, Beghi A, Fontana M, Lini E, Marini P et al. Spontaneous reparation of post-traumatic tympanic perforation: an experimental study in rats [in Italian]. Acta Otorhinolaryngol Ital 1990;10:559–77
57 Boedts D. The tympanic epithelium in normal and pathological conditions. Acta Otorhinolaryngol Belg 1978;32:295419
58 Lou Z, Wang Y, Su K. Comparison of the healing mechanisms of human dry and endogenous wet traumatic eardrum perforations. Eur Arch Otorhinolaryngol 2014;271:2153–7
59 Lou ZC, Tang YM, Yang J. A prospective study evaluating spontaneous healing of aetiology, size and type-different groups of traumatic tympanic membrane perforation. Clin Otolaryngol 2011;36:450–60
60 Lou ZC. Spontaneous healing of traumatic eardrum perforation: outward epithelial cell migration and clinical outcome. Otolaryngol Head Neck Surg 2012;147:1114–19
61 Lou ZC. Late crust formation as a predictor of healing of traumatic, dry, and minor-sized tympanic membrane perforations. Am J Otolaryngol 2013;34:282–6
62 Lou ZC, Tang YM, Chen HY, Xiao J. The perforation margin phenotypes and clinical outcome of traumatic tympanic membrane perforation with a gelfoam patch: our experience from a retrospective study of seventy-four patients. Clin Otolaryngol 2015;40:389–92
63 Fagan P, Patel N. A hole in the drum. An overview of tympanic membrane perforations. Aust Fam Physician 2002;31:707–10
64 Park SN, Kim HM, Jin KS, Maeng JH, Yeo SW, Park SY. Predictors for outcome of paper patch myringoplasty in patients with chronic tympanic membrane perforations. Eur Arch Otorhinolaryngol 2015;272:297301
65 Spandow O, Hellström S, Dahlström M, Bohlin L. Comparison of the repair of permanent tympanic membrane perforations by hydrocolloidal dressing and paper patch. J Laryngol Otol 1995;109:1041–7
66 Koch WM, Friedman EM, McGill TJ, Healy GB. Tympanoplasty in children: the Boston Children's Hospital experience. Arch Otolaryngol Head Neck Surg 1990;116:3540
67 Caylan R, Titiz A, Falcioni M, De Donato G, Russo A, Taibah A et al. Myringoplasty in children: factors influencing surgical outcome. Otolaryngol Head Neck Surg 1998;118:709–13
68 Ophir D, Porat M, Marshak G. Myringoplasty in the pediatric population. Arch Otolaryngol Head Neck Surg 1987;113:1288–90
69 Lou ZC, Yang J, Tang Y, Fu Y. Topical application of epidermal growth factor with no scaffold material on the healing of human traumatic tympanic membrane perforations. Clin Otolaryngol 2016;41:744–9
70 Güneri EA, Tekin S, Yilmaz O, Ozkara E, Erdağ TK, Ikiz AO et al. The effects of hyaluronic acid, epidermal growth factor, and mitomycin in an experimental model of acute traumatic tympanic membrane perforation. Otol Neurotol 2003;24:371–6
71 Ozturk K, Yaman H, Cihat Avunduk M, Arbag H, Keles B, Uyar Y. Effectiveness of MeroGel hyaluronic acid on tympanic membrane perforations. Acta Otolaryngol 2006;126:1158–63
72 Kälicke T, Köller M, Frangen TM, Schlegel U, Sprutacz O, Printzen G et al. Local application of basic fibroblast growth factor increases the risk of local infection after trauma: an in-vitro and in-vivo study in rats. Acta Orthop 2007;78:6373
73 Derlacki EL. Repair of central perforations of tympanic membrane. AMA Arch Otolaryngol 1953;58:405–20
74 Spratley J, Hellström S, Eriksson PO, Pais-Clemente M. Myringotomy delays the tympanic membrane recovery in acute otitis media: a study in the rat model. Laryngoscope 2002;112:1474–81
75 Jackman A, Ward R, April M, Bent J. Topical antibiotic induced otomycosis. Int J Pediatr Otorhinolaryngol 2005;69:857–60
76 Winerman I, Man A, Segal S. Early repair of traumatic perforations of the tympanic membrane in children. Int J Pediatr Otorhinolaryngol 1982;4:23–7
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 18
Total number of PDF views: 71 *
Loading metrics...

Abstract views

Total abstract views: 259 *
Loading metrics...

* Views captured on Cambridge Core between 15th May 2017 - 14th December 2017. This data will be updated every 24 hours.