Hostname: page-component-8448b6f56d-mp689 Total loading time: 0 Render date: 2024-04-18T05:25:39.970Z Has data issue: false hasContentIssue false

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

Published online by Cambridge University Press:  15 May 2017

Z C Lou*
Affiliation:
Department of Otorhinolaryngology, Affiliated YiWu Hospital of Wenzhou Medical University, Zhejiang, China
Z H Lou
Affiliation:
Department of Clinical Medicine, Xinxiang Medical University, Henan, China
*
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

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.

Type
Review Articles
Copyright
Copyright © JLO (1984) Limited 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Griffin, WL Jr. A retrospective study of traumatic tympanic membrane perforations in a clinical practice. Laryngoscope 1979;89:261–82Google Scholar
2 Ott, MC, Lundy, LB. Tympanic membrane perforation in adults: how to manage, when to refer. Postgrad Med 2001;110:81–4CrossRefGoogle ScholarPubMed
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 Google Scholar
4 Orji, FT, Agu, CC. Determinants of spontaneous healing in traumatic perforations of the tympanic membrane. Clin Otolaryngol 2008;33:420–6Google Scholar
5 Gladstone, HB, Jackler, RK, Varav, K. Tympanic membrane wound healing. An overview. Otolaryngol Clin North Am 1995;28:913–32Google Scholar
6 Fina, M, Baird, A, Ryan, A. Direct application of basic fibroblast growth factor improves tympanic membrane perforation healing. Laryngoscope 1993;103:804–9Google Scholar
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;121:43–7CrossRefGoogle ScholarPubMed
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;33:410–18CrossRefGoogle ScholarPubMed
9 von Unge, M, Dirckx, JJ, Olivius, NP. Embryonic stem cells enhance the healing of tympanic membrane perforations. Int J Pediatr Otorhinolaryngol 2003;67:215–19Google Scholar
10 Fina, M, Bresnick, S, Baird, A, Ryan, A. Improved healing of tympanic membrane perforations with basic fibroblast growth factor. Growth Factors 1991;5:265–72Google Scholar
11 Mondain, M, Saffiedine, S, Uziel, A. Fibroblast growth factor improves the healing of experimental tympanic membrane perforations. Acta Otolaryngol 1991;111:337–41CrossRefGoogle ScholarPubMed
12 Vrabec, JT, Schwaber, MK, Davidson, JM, Clymer, MA. Evaluation of basic fibroblast growth factor in tympanic membrane repair. Laryngoscope 1994;104:1059–64Google Scholar
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;126:156–62Google Scholar
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;41:564–70CrossRefGoogle ScholarPubMed
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;37:294–8CrossRefGoogle Scholar
16 Yamazaki, K, Ishijima, K, Sato, H. A clinical study of traumatic tympanic membrane perforation [in Japanese]. Nihon Jibiinkoka Gakkai Kaiho 2010;113:679–86Google Scholar
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;37:735–41Google Scholar
18 Buyten, J, Kaufman, G, Ryan, M. Effects of ciprofloxacin/dexamethasone and ofloxacin on tympanic membrane perforation healing. Otol Neurotol 2007;28:887–90CrossRefGoogle ScholarPubMed
19 Amadasun, JE. An observational study of the management of traumatic tympanic membrane perforations. J Laryngol Otol 2002;116:181–4Google Scholar
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;273:2503–8Google Scholar
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;30:115–20CrossRefGoogle ScholarPubMed
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:MC01–03Google ScholarPubMed
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;129:945–9Google Scholar
24 Tan, HE, Santa Maria, PL, Eikelboom, RH, Anandacoomaraswamy, KS, Atlas, MD. Type I tympanoplasty meta-analysis: a single-variable analysis. Otol Neurotol 2016;37:838–46Google Scholar
25 Sckolnick, JS, Mantle, B, Li, J, Chi, DH. Pediatric myringoplasty: factors that affect success--a retrospective study. Laryngoscope 2008;118:723–9Google Scholar
26 Albera, R, Ferrero, V, Lacilla, M, Canale, A. Tympanic reperforation in myringoplasty: evaluation of prognostic factors. Ann Otol Rhinol Laryngol 2006;115:875–9Google Scholar
27 Adkins, WY, White, B. Type I tympanoplasty: influencing factors. Laryngoscope 1984;94:916–18Google Scholar
28 Vartiainen, E, Kärjä, J, Karjalainen, S, Härmä, R. Failures in myringoplasty. Arch Otorhinolaryngol 1985;242:2733 CrossRefGoogle ScholarPubMed
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;58:165–7Google Scholar
30 Odland, GF. The fine structure of the interrelationship of cells in the human epidermis. J Biophys Biochem Cytol 1958;4:529–38Google Scholar
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;193:293–4Google Scholar
32 Hinman, CD, Maibach, H. Effect of air exposure and occlusion on experimental human skin wounds. Nature 1963;200:377–8Google Scholar
33 Zahir, M. Effect of scabs on the rate of epidermal regeneration in the skin wounds of guinea pigs. Nature 1963;199:1013–14Google Scholar
34 Rovee, DT, Kurowsky, CA, Labun, J. Local wound environment and epidermal healing: mitotic response. Arch Dermatol 1972;106:330–4Google Scholar
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;35:142–8Google Scholar
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;124:392–5Google Scholar
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 Google Scholar
38 Dowsett, C, Ayello, E. TIME principles of chronic wound bed preparation and treatment. Br J Nurs 2004;13:S1623 Google Scholar
39 Okan, D, Woo, K, Ayello, EA, Sibbald, G. The role of moisture balance in wound healing. Adv Skin Wound Care 2007;20:3953 CrossRefGoogle ScholarPubMed
40 Schultz, G, Mast, B. Molecular analysis of the environment of healing and chronic wounds: cytokines, proteases and growth factors. Wounds 1998;10:19F Google Scholar
41 Mast, BA, Schultz, GS. Interactions of cytokines, growth factors, and proteases in acute and chronic wounds. Wound Repair Regen 1996;4:411–20Google Scholar
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 Google Scholar
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;106:602–14Google Scholar
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 499–500Google Scholar
45 Dunlap, AM, Schuknecht, HF. Closure of perforations of the tympanic membrane. Laryngoscope 1947;57:479–90Google Scholar
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 CrossRefGoogle ScholarPubMed
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;49:150–60Google Scholar
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;14:811–19Google Scholar
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;115:50–4Google Scholar
50 Mondain, M, Ryan, A. Histological study of the healing of traumatic tympanic membrane perforation after basic fibroblast growth factor application. Laryngoscope 1993;103:312–18CrossRefGoogle ScholarPubMed
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;122:468–73Google Scholar
52 Wang, WQ, Wang, ZM, Chi, FL. Spontaneous healing of various tympanic membrane perforations in the rat. Acta Otolaryngol 2004;124:1141–4Google Scholar
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;80:330–8CrossRefGoogle ScholarPubMed
54 Makino, K, Amatsu, M, Kinishi, M, Mohri, M. Epithelial migration in the healing process of tympanic membrane perforations. Eur Arch Otorhinolaryngol 1990;247:352–5CrossRefGoogle ScholarPubMed
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;71:802–12Google Scholar
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;10:559–77Google ScholarPubMed
57 Boedts, D. The tympanic epithelium in normal and pathological conditions. Acta Otorhinolaryngol Belg 1978;32:295419 Google Scholar
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;271:2153–7CrossRefGoogle ScholarPubMed
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;36:450–60Google Scholar
60 Lou, ZC. Spontaneous healing of traumatic eardrum perforation: outward epithelial cell migration and clinical outcome. Otolaryngol Head Neck Surg 2012;147:1114–19Google Scholar
61 Lou, ZC. Late crust formation as a predictor of healing of traumatic, dry, and minor-sized tympanic membrane perforations. Am J Otolaryngol 2013;34:282–6Google Scholar
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;40:389–92Google Scholar
63 Fagan, P, Patel, N. A hole in the drum. An overview of tympanic membrane perforations. Aust Fam Physician 2002;31:707–10Google ScholarPubMed
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 Google Scholar
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;109:1041–7Google Scholar
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 Google Scholar
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;118:709–13Google Scholar
68 Ophir, D, Porat, M, Marshak, G. Myringoplasty in the pediatric population. Arch Otolaryngol Head Neck Surg 1987;113:1288–90Google Scholar
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;41:744–9Google Scholar
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;24:371–6Google Scholar
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;126:1158–63Google Scholar
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 Google Scholar
73 Derlacki, EL. Repair of central perforations of tympanic membrane. AMA Arch Otolaryngol 1953;58:405–20CrossRefGoogle ScholarPubMed
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;112:1474–81Google Scholar
75 Jackman, A, Ward, R, April, M, Bent, J. Topical antibiotic induced otomycosis. Int J Pediatr Otorhinolaryngol 2005;69:857–60Google Scholar
76 Winerman, I, Man, A, Segal, S. Early repair of traumatic perforations of the tympanic membrane in children. Int J Pediatr Otorhinolaryngol 1982;4:23–7Google Scholar