Natural History of Pediatric Tympanic Membrane Perforation

Rollin, Matthew; Rogers, Pauline; Robinson, Philip

doi:10.1097/mao.0b013e318200a0fc

Cited by 12 publications

(6 citation statements)

References 15 publications

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“…The observed rate of ongoing perforation in this study (1.9% for 580 ears) is consistent with the rate of persistent perforation (2.2% for 8107 ears) reported in a meta‐analysis of short‐term tubes 24 . It has been reported that 90% of posttympanostomy perforations close spontaneously after 2.5 years for children younger than 7 years 34 . Patients in the current study exited upon tube extrusion, and, therefore, improvement or resolution of perforations could not always be assessed.…”

Section: Discussionsupporting

confidence: 91%

Two‐Year Outcomes After Pediatric In‐Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System

Waldman

Ingram

Vidrine

et al. 2023

Otolaryngol.--head neck surg.

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ObjectiveEvaluate 2‐year outcomes after lidocaine/epinephrine iontophoresis and tympanostomy using an automated tube delivery system for pediatric tube placement in‐office.Study DesignProspective, single‐arm.SettingEighteen otolaryngology practices.MethodsChildren age 6 months to 12 years indicated for tympanostomy were enrolled between October 2017 and February 2019. Local anesthesia of the tympanic membrane was achieved via lidocaine/epinephrine iontophoresis and tympanostomy was completed using an automated tube delivery system (the Tula® System). An additional Lead‐In cohort of patients underwent tube placement in the operating room (OR) under general anesthesia using only the tube delivery system. Patients were followed for 2 years or until tube extrusion, whichever occurred first. Otoscopy and tympanometry were performed at 3 weeks, and 6, 12, 18, and 24 months. Tube retention, patency, and safety were evaluated.ResultsTubes were placed in‐office for 269 patients (449 ears) and in the OR for 68 patients (131 ears) (mean age, 4.5 years). The median and mean times to tube extrusion for the combined OR and In‐Office cohorts were 15.82 (95% confidence interval [CI]: 15.41‐19.05) and 16.79 (95% CI: 16.16‐17.42) months, respectively. Sequelae included ongoing perforation for 1.9% of ears (11/580) and medial tube displacement for 0.2% (1/580) observed at 18 months. Over a mean follow‐up of 14.3 months, 30.3% (176/580) of ears had otorrhea and 14.3% (83/580) had occluded tubes.ConclusionIn‐office pediatric tympanostomy using lidocaine/epinephrine iontophoresis and automated tube delivery results in tube retention within the ranges described for similar grommet‐type tubes and complication rates consistent with traditional tube placement in the OR.

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Section: Discussionsupporting

confidence: 91%

Two‐Year Outcomes After Pediatric In‐Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System

Waldman

Ingram

Vidrine

et al. 2023

Otolaryngol.--head neck surg.

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“…These misclassifications of exposure may have compromised correct assignment of patients to exposure groups and biased our results toward the null hypothesis (no effect or HR = 1). Third, although our 12‐month follow‐up time period is expected to comprise the time period where TTs remain patent 26 and perforations have not healed, 27 some tympanic membranes might have been intact by the time of neomycin administration and thus not susceptible to toxic effects. We attempted a sensitivity analysis stratified by initiation of study eardrops relative to diagnosis of NITM, but our sample size became too small for meaningful inferences.…”

Section: Discussionmentioning

confidence: 99%

Sensorineural Hearing Loss Associated with Neomycin Eardrops and Nonintact Tympanic Membranes

Winterstein

Liu

et al. 2012

Otolaryngol.--head neck surg.

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“…Additional studies have demonstrated clonogenic capacity and migratory behavior of epithelial cells derived from the mouse and human TM in vitro (Redmond et al 2011;Liew et al 2017;Ong et al 2017;Liew et al 2018). It is further clear that following perforation of the TM there is a massive cellular response typically leading to the rapid healing in all mammals, including humans, investigated thus far (Santa Maria et al 2010;Rollin et al 2011;Lou et al 2012;Chari et al 2019). However, our knowledge of the cellular identities, dynamics, and mechanisms of TM homeostasis is otherwise limited.…”

Section: Introductionmentioning

confidence: 97%

A hierarchy of migratory keratinocytes maintains the tympanic membrane

Frumm¹,

Yu²,

Chang³

et al. 2019

Preprint

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Although the conductive function of the tympanic membrane (TM) is critical for hearing, it is unknown how the organ maintains cellular homeostasis. Using a combination of single-cell RNA sequencing, lineage tracing, whole-organ explant, and live-cell imaging, we demonstrate that the stem cells of the TM epidermis reside in a distinct location at the superior portion of the TM and, as progeny migrate inferiorly, Pdgfra+ fibroblasts maintain a niche supporting proliferation of committed progenitors, while keratinocytes distal from the niche differentiate. Thus, the TM has a three dimensional differentiation hierarchy of keratinocytes distinct from that at other epidermal sites. The TM represents a physiological context where, in the absence of injury, keratinocytes both transit through a proliferative committed progenitor state and exhibit directional lateral migration.This work forms a foundation for understanding common disorders of the TM and introduces a new model system for the understanding of keratinocyte biology. 1N).The same approaches were utilized to define and locate the cell populations in the fibrous/mucosal fraction, where 12 clusters were discovered. Among these are multiple Vimentin+ (Vim) mesenchymal populations, including: endothelium (Pecam1+), smooth muscle (Acta2+), and Schwann cells (Mbp+) (Figure S3). Four additional clusters of mesenchymal cells were identified, numbered 0, 2, 3, and 5. Inspection of the differentially expressed genes revealed that cluster 0 is Gpx3+, and clusters 2, 3, and 5 are Igfbp3+ (Figure S4A-B). ISH confirmed that Gpx3 and Igfbp3 do indeed mark distinct populations of fibroblasts (Figure S4C). The Gpx3+ cells appear to reside in proximity to bony elements-specifically, in the annular region and near the malleus. The Igfbp3+ cells are more diffusely spread throughout the fibrous layer of the TM.Lastly, Sox2 is a known marker of mucosa, and is expressed in both non-ciliated (clusters 4 and 11)

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Natural History of Pediatric Tympanic Membrane Perforation

Abstract: When faced with the clinical question of what period of watchful waiting would be appropriate in monitoring a perforated tympanic membrane, before intervention may reasonably be recommended; there seems to be little advantage in waiting longer than 2.5 years.

Cited by 12 publications

References 15 publications

Two‐Year Outcomes After Pediatric In‐Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System

Two‐Year Outcomes After Pediatric In‐Office Tympanostomy Using Lidocaine/Epinephrine Iontophoresis and an Automated Tube Delivery System

Sensorineural Hearing Loss Associated with Neomycin Eardrops and Nonintact Tympanic Membranes

A hierarchy of migratory keratinocytes maintains the tympanic membrane

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