Hyaluronic Acid in Middle Ear Surgery

Bagger‐Sjöbäck, Dan; Holmquist, Jörgen; Mendel, L.; Mercke, Ulf

doi:10.1097/00129492-199309000-00016

Cited by 23 publications

(40 citation statements)

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“…HA and gelatin (hydrolyzed collagen) are both natural polymers able to release entrapped therapeutic molecules by enzymatic degradation, and they are currently studied as potential inner ear delivery systems [Nakagawa and Ito, 2008]. The HA safety profile, biocompatibility and wound-healing and adhesion prevention properties are well established in the guinea pig middle ear Bagger-Sjöbäck et al, 1993;Saber et al, 2009]. Additionally, no complications have been reported associated with its use in the human middle ear [Arriaga and Goldman, 1998;Gouveris et al, 2005;Selivanova et al, 2005;Angeli, 2006].…”

Section: Discussionmentioning

confidence: 99%

“…HA tends to form large three-dimensional structures with a high density of negative charges, which attracts osmotically active cations and water, creating a hydrated gel [Friberg et al, 1989;Bagger-Sjöbäck, 1991;Bagger-Sjöbäck et al, 1993]. The exact mechanism of action of HA in drug delivery in the middle ear is not known, but several postulates have been given: (1) HA has been proposed to act most likely by osmotic effect on the perilymph Friberg et al, 1989;Bagger-Sjöbäck, 1991;Bagger-Sjöbäck et al, 1993]; (2) HA might have a potential role in modulating the RWM permeability [Selivanova et al, 2003], and (3) HA has demonstrated rheologic properties, which may not directly affect drugs crossing the round window membrane, but rather alter blood viscosity, thus improving blood flow and oxygen delivery [Bothner and Wik, 1987]. The application of HA to the inner ear of guinea pigs for up to 28 days caused no detectable morphologic or functional changes at any level of the cochlea or vestibular end organs Bagger-Sjöbäck et al, 1993].…”

mentioning

confidence: 99%

“…The exact mechanism of action of HA in drug delivery in the middle ear is not known, but several postulates have been given: (1) HA has been proposed to act most likely by osmotic effect on the perilymph Friberg et al, 1989;Bagger-Sjöbäck, 1991;Bagger-Sjöbäck et al, 1993]; (2) HA might have a potential role in modulating the RWM permeability [Selivanova et al, 2003], and (3) HA has demonstrated rheologic properties, which may not directly affect drugs crossing the round window membrane, but rather alter blood viscosity, thus improving blood flow and oxygen delivery [Bothner and Wik, 1987]. The application of HA to the inner ear of guinea pigs for up to 28 days caused no detectable morphologic or functional changes at any level of the cochlea or vestibular end organs Bagger-Sjöbäck et al, 1993]. The average elimination time of HA in the middle ear of guinea pigs has been reported to range from 1 to 5 days Engström et al, 1987;Chandrasekhar et al, 2000].…”

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confidence: 99%

“…The viscous properties of HA, its safety profile and its presence in the middle ear for an extended period of time support its function as a suitable middle ear packing agent and a potential vehicle for drug delivery to the inner ear [Bagger-Sjöbäck et al, 1993;Krupala et al, 1998;Li et al, 2001;Jang et al, 2008]. However, the efficiency of HA as a carrier agent for IT delivery appears to be dependent on the specific drug being delivered and on the gel composition [Kelly et al, 1999;Chandrasekhar et al, 2000;Sheppard et al, 2004;Endo et al, 2005;Tsuyoshi et al, 2005;Yildirim et al, 2005;Coleman et al, 2007;James et al, 2008;Saber et al, 2009].…”

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confidence: 99%

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Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Borden¹,

Saunders

Berryhill

et al. 2010

Audiol Neurotol

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Background: The use of intratympanic (IT) steroids for the treatment of inner ear disorders is promising, but the clinical challenges of prolonged middle ear drug application have proven burdensome, and a sustainable delivery system is yet to be developed. Method: In this study, a guinea pig model was used to determine if dexamethasone in combination with a hyaluronic-acid (HA)-based hydrogel is an efficient, stable and sustainable dexamethasone delivery system to the inner ear. For each animal, right and left middle ear bullae were randomly selected to be filled with dexamethasone alone or dexamethasone-HA (Dex-HA) gel. Perilymph samples were collected at different time points and dexamethasone levels were determined using an ELISA. Results: Dexamethasone was measurable in the perilymph samples up to 72 h after treatment. At 24 h after treatment, the perilymph dexamethasone concentrations were significantly higher (p = 0.01) in the ears treated with Dex-HA gel than in those treated with dexamethasone alone. While the perilymph dexamethasone concentration had decreased at 48 h after treatment with Dex-HA gel, the levels were still higher than those observed at 24 h in ears treated with dexamethasone alone. A high variability in dexamethasone concentration was observed between the samples, and the variability between matched ears receiving different treatments was remarkably lower than the variability within each treatment group, suggesting that individual parameters might play a major role in perilymph dexamethasone concentration. There was no statistically significant correlation between dexamethasone concentration and sex, weight or laterality. Conclusions: Our results show that the Dex-HA gel used in this study provides an effective and sustained dexamethasone release mechanism that might be utilized to treat conditions such as sudden sensorineural hearing loss. This could potentially reduce the morbidity and costs associated with IT treatment.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Borden¹,

Saunders

Berryhill

et al. 2010

Audiol Neurotol

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“…[6][7][8] Hyaluronic acid has also been used as packing in clinical otological surgery and in animal experiments. 9,10 These studies have suggested that HA was equivalent to or superior to AGS.…”

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confidence: 99%

Evaluation of Esterified Hyaluronic Acid as Middle Ear–Packing Material

Li¹,

Feghali²,

Dinces³

et al. 2001

Arch Otolaryngol Head Neck Surg

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Objective: To evaluate the efficacy of esterified hyaluronic acid (MeroGel) as a middle ear (ME)-packing material.Design: Randomized controlled trial.Material: Twenty-four guinea pigs.Intervention: Group 1, MeroGel-treated animals (n=10), bilateral wounding of ME mucosa with 5 of the animals receiving the MeroGel packing in the left ME and 5 of the animals receiving MeroGel in the right ME; group 2, absorbable gelatin sponge-treated animals (n=10), with the same experimental protocol as in group 1 except that the absorbable gelatin sponge was the packing material; group 3, untreated animals (n=4), unilateral wounding of the left ME mucosa in 2 animals and in 2 animals in the right ME, with no packing material. Auditory brainstem recordings were performed for all groups before the ME operation and 5 days and 6 weeks after the operation.Results: Auditory brainstem response recordings at postoperative day 5 showed that all ears with ME packing had hearing losses in the frequency range of 500 to 4000 Hz. The recovery of hearing acuity at postoperative week 6 was significantly better in group 1 (MeroGel-treated) guinea pigs compared with group 2 (the absorbable gelatin sponge-treated) animals. In group 2 animals, 20% of the packing material remained in the ME cavities and new bone formation was observed, while in group 1 animals, there was less packing material in the ME and no formation of new bone. Conclusions:MeroGel is a nonototoxic packing material with a high level of biocompatibility for ME mucosa; it is an effective supportive material following ME surgery and is easily expelled from the ME cavity.

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To pack or not to pack? A contemporary review of middle ear packing agents

et al. 2011

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Middle ear packing agents are used in otologic surgery to provide support to the middle ear structures, maintain aeration of the middle ear, and promote hemostasis. However, there is currently a lack of standardization regarding the use of different types of packing agents. The choice of materials and how they are used remain controversial. In fact, some have recently advocated for no packing. In view of this, this review focuses on the types of materials available, a brief historical account of each material, characteristics of an ideal packing agent, and a discussion on the techniques of insertion to optimize surgical outcomes.

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Hyaluronic Acid in Middle Ear Surgery

Cited by 23 publications

References 0 publications

Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane

Evaluation of Esterified Hyaluronic Acid as Middle Ear–Packing Material

To pack or not to pack? A contemporary review of middle ear packing agents

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