Histological Study of The Healing of Traumatic Tympanic Membrane Perforation After Vivosorb and Epifilm Application

Abstract

Background: Untreated traumatic tympanic membrane perforations (TMPs) may lead to permanent perforations and hearing loss. There are many materials that have been previously used for repairing the TMPs. Aims and Objectives: The purpose of this study is to evaluate the clinical and histological effects of Vivosorb (Vv) and Epifilm on healing of TMPs in a rat model. Material and Methods: The posterior-inferior quadrant of the tympanic membranes (TMs) in right ears of 14 rats was perforated using a 20-g needle and then the animals were randomly divided into 2 equal groups (n = 7). The perforated right TMs were treated with either Vv (Vv group) or Epifilm (Ep group). The left TMs of 7 rats were perforated in same way and allowed to close spontaneously without any topical material applications (spontaneous closure group as sham control, SC). The left tympanic membranes of the other 7 rats were not perforated and used as normal controls (NC group). On postoperative 15th day, tympanic bullas were extracted from killed rats and examined morphometrically and histopathologically. Results: Perforation closure rate was 85.7% (6/7) in both Vv and SC groups. Perforations of Ep group closed in 7/7 (100%) ears. The thicknesses of the perforated membranes were increased in SC and especially Vv groups. Also, connective tissue fibrosis, blood clots, and epithelial degenerations were detected in SC and Vv groups. The mean fibroblastic reaction scores of Vv, Ep, and SC groups were 2.14(+), 0.57(+), and 1.71(+) respectively, on comparison with NC group. The mean neovascularization score was 1.42(+) in Vv group, 0.14(+) in Ep group, and 0.57(+) in SC group. Conclusion and Significance: Vivosorb and especially Epifilm can improve the healing process in traumatic TMPs and additionally, Epifilm might be more preferred for the treatment of TMPs because of causing lesser fibrosis.

Tissue engineering and regenerative medicine strategies for the repair of tympanic membrane perforations

“…In a rat traumatic acute TM perforation model, Yilmaz et al. results corroborated HyA (EpiFilm®) capacity to induce healing with lesser fibrosis [16] .…”

Evaluation of acoustic changes in and the healing outcomes of rat eardrums with pars tensa and pars flaccida perforations

“…Stained images were collected using a microscope and imaging system (DM3000; Leica), and the mean TM thickness was determined using ImageJ (ver. 1.8.0) at three sites evenly spaced along the perforated TM cross‐section, and at similar sites of normal and regenerated TMs 21 …”

“…1.8.0) at three sites evenly spaced along the perforated TM cross‐section, and at similar sites of normal and regenerated TMs. 21 …”

“…1.8.0) at three sites evenly spaced along the perforated TM cross-section, and at similar sites of normal and regenerated TMs. 21 control groups (before perforation), followed by post hoc testing (Sidak multiple comparisons) at each test frequency. The unpaired Student's t test was used to compare the unpaired PTP and PFP groups at each test frequency.…”

Developmental aspects of the tympanic membrane: Shedding light on function and disease

“…Furthermore, it is commonly observed clinically that a perforated TM heals its three‐ply structure upon an initial epidermal scaffold (Johnson, Smallman, & Kent, ). While the lamina propria with its collagenous content appears a likely scaffolding layer, experiments in rodents suggest that repair starts with the epithelial layer, repairing inwards (Araújo, Murashima, Alves, Jamur, & Hyppolito, ; Yilmaz et al, ). It appears likely that the regenerative zones in the outer TM layers receive signals from the middle mesenchymal layer.…”