Early Tympanoplasty Using a Synthetic Biomembrane for Military-Related Blast Induced Large Tympanic Membrane Perforation

Abstract

Early myringoplasty using a biomembrane for blast injury-induced large tympanic perforation is a fast and minimally invasive method to achieve earlier tympanic closure and a higher closure rate for safe recovery of activity. It can be performed under general anesthesia concurrently with surgery for additional body-wide trauma. The deployment of ENT surgeons on the battlefield in the French Army has enabled early management of these patients.

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

“…Across all studies, closure rates were found to be 82.1%, but acute perforations demonstrated significantly higher closure rates than chronic perforations (89.9% vs. 64.9%, P < .01). Spontaneous closure rates for acute perforations ranged from 40% to 100% 23,31,49,55 . Thus, the duration of perforation was found to be a significant independent variable determining tympanoplasty outcomes, regardless of the material utilized.…”

“…Three publications reported the use of esterified hyaluronic acid film (EpiFilm/EpiDisc; Medtronic, Dublin, Ireland) as a graft material in a total of 88 adult and pediatric patients (Table II). 49–51 Across all studies (n = 88) the mean (weighted average) closure rate was 89.8% for hyaluronic acid film (Table III). TM repair was performed by a transcanal technique with local anesthesia.…”

“…Chronic TM perforations were only included in one study of five patients; however, the researchers prematurely terminated the study due to the 0% closure rate 50 . In the other two studies, all perforations were a result of acute trauma, and approximately 73% were grade 1 49,51 . The largest of those studies, which included 74 ears patched with hyaluronic acid film, reported a closure rate of 94.8% and significant ABG closure of 3.4 dB.…”

Design for a cohort-randomized trial of an acceptance and commitment therapy-enhanced weight management and fitness program for Navy personnel

“…Among 313,513 Navy personnel who underwent the PFA in the first half of 2012, the overall BCA failure rate was 2.2% (2.0% for men, 3.4% for women) with substantially higher failure rates among those with higher BMI [2]. Within the Naval Medical Center San Diego (NMCSD), the PFA failure rate per cycle in years 2013–2014 was 4% (128 sailors on average), with the majority of failures resulting from BCA noncompliance [6]. There is a need for effective and easily deployable interventions to boost weight management and fitness efforts, increase the likelihood of passing the PFA, and help retain a valued and highly trained military force that can meet all mission demands.…”

“…SS is an evidence-based weight management program that promotes healthy weight loss through nutritional, behavioral, and exercise education. The latest statistics available from January–June 2013 on SS across the country indicate that of the 393 sailors enrolled, 297 completed the program (76%), and only 45% of completers met the BCA component of PFA standards at 6-month follow-up [6]. We propose that SS falls short on meeting its goals because it does not adequately address underlying behavioral, psychological, and emotional barriers that influence problematic eating and poor exercise habits.…”