Silicon foil patching for blast tympanic membrane perforation: a retrospective study

Branica, Srećko; Dawidowsky, Krsto; Bilić, Lana Kovač; Bilić, Mario

doi:10.3325/cmj.2019.60.503

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…Two studies reported a total of 189 pediatric and adult cases of acute, traumatic TM perforations splinted with a silicone foil (Silastic) 72,73 . Although the mean (weighted average) closure rate across studies (n = 189) was 64.6%, there was substantial variation between the two studies (range, 51.6%–91.8%).…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

et al. 2020

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Objectives Nonautologous graft materials may solve several dilemmas in tympanoplasty by obviating the need for graft harvest, facilitating consistent wound healing, and permitting graft placement in the clinical setting. Prior studies of nonautologous grafts in humans have shown variable outcomes. In this systematic review, we aim to 1) summarize clinical outcomes and 2) discuss limitations in the literature regarding nonautologous grafts for tympanoplasty in humans. Methods A literature review was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) recommendations. The study size, etiology and duration of perforation, type of nonautologous graft, and postoperative closure rate were assessed. Results The PRISMA approach yielded 61 articles, including 3,247 ears that met inclusion criteria. Studies evaluated nonautologous grafts including paper patch, gelatin sponge, growth factors, porcine small‐intestinal submucosa, among others. Traumatic perforations (62.3%) were most commonly studied, whereas postinfectious perforations (31.9%) and other etiologies (5.8%) comprised a minority of cases. Acute perforations of <8 weeks duration constituted just over half of all treated ears. Overall closure rate was 82.1%, with significantly higher closure rates in acute (89.9%) versus chronic perforations (64.9%, P < .01), regardless of material. A median postoperative air‐bone gap of 5.6 dB was found in the 23% of studies reporting this metric. Conclusions The majority of publications reviewing nonautologous materials in tympanoplasty evaluate acute or traumatic perforations, and few rigorously report hearing outcomes. Given available data, porcine submucosa and basic fibroblast growth factor may hold promise for chronic perforation closure. Future studies should report closure rates and hearing outcomes in perforations >8 weeks duration. Laryngoscope, 131:392–400, 2021

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Section: Resultsmentioning

confidence: 99%

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

et al. 2020

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“…According to the Armed Forces Health Surveillance Branch, Defense Medical Surveillance System, and the Theater Medical Data Store, there were roughly 204,000 worldwide cases for TBI diagnosed by the U.S. Department of Defense ("DoD") between 2010 and 2017 (Defense and Veterans Brain Injury Center 2020), and over 60% of these were likely caused by blasts (Regasa et al 2019). High-explosive blasts may expose SMs to pressure levels that are not enough to affect other body systems, but enough to damage neurological structures that are known to play an important role in auditory processing (Branica et al 2008;Ling et al 2009;Chafi et al 2010), and multiple sensory cortical and subcortical regions may be affected. Other studies suggest that the central nervous system, including the temporal, frontal, and subcortical regions and the brainstem, are particularly vulnerable to blast-injury (Povlishock & Katz 2005;Taber et al 2006;Chafi et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds

et al. 2021

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Objectives: Over the past decade, U.S. Department of Defense and Veterans Affairs audiologists have reported large numbers of relatively young adult patients who have normal to near-normal audiometric thresholds but who report difficulty understanding speech in noisy environments. Many of these service members also reported having experienced exposure to explosive blasts as part of their military service. Recent studies suggest that some blast-exposed patients with normal to near-normal-hearing thresholds not only have an awareness of increased hearing difficulties, but also poor performance on various auditory tasks (sound source localization, speech recognition in noise, binaural integration, gap detection in noise, etc.). The purpose of this study was to determine the prevalence of functional hearing and communication deficits (FHCD) among healthy Active-Duty service men and women with normal to near-normal audiometric thresholds. Design:To estimate the prevalence of such FHCD in the overall military population, performance of roughly 3400 Active-Duty service members with hearing thresholds mostly within the normal range were measured on 4 hearing tests and a brief 6-question survey to assess FHCD. Subjects were subdivided into 6 groups depending on the severity of the blast exposure (3 levels: none, far away, or close enough to feel heat or pressure) and hearing thresholds (2 levels: audiometric thresholds of 20 dB HL or better, slight elevation in 1 or more thresholds between 500 and 4000 Hz in either ear).Results: While the probability of having hearing difficulty was low (≈4.2%) for the overall population tested, that probability increased by 2 to 3 times if the service member was blast-exposed from a close distance or had slightly elevated hearing thresholds (>20 dB HL). Service members having both blast exposure and mildly elevated hearing thresholds exhibited up to 4 times higher risk for performing abnormally on auditory tasks and more than 5 times higher risk for reporting abnormally low ratings on the subjective questionnaire, compared with service members with no history of blast exposure and audiometric thresholds ≤20 dB HL. Blast-exposed listeners were roughly 2.5 times more likely to experience subjective or objective hearing deficits than those with noblast history.Conclusions: These elevated rates of abnormal performance suggest that roughly 33.6% of Active-Duty service members (or approximately 423,000) with normal to near-normal-hearing thresholds (i.e., H1 profile) are at some risk for FHCD, and about 5.7% (approximately 72,000) are at high risk, but are currently untested and undetected within the current fitness-for-duty standards. Service members identified as "at risk" for FHCD according to the metrics used in the present study, in spite of their excellent hearing thresholds, require further testing to determine whether they have sustained damage to peripheral and early-stage auditory processing (bottom-up processing), damage to cognitive processes for speech (top-down processing), or bo...

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“…As an alternative procedure, simple silicone foils can be used to sustain the healing process, reducing the risk of ear infections and possibly improving hearing abilities for small and medium TMPs. [ 35,36 ] In a clinical study, polydimethylsiloxane (PDMS) films, in combination with immobilized collagen, were used to treat small TMPs with a success rate of 70%. [ 37 ] We previously proposed the soft skin adhesive SSA MG7‐9800 for this purpose due to its reliable but gentle self‐adhesion to tissues, enabling secure adherence and atraumatic removal.…”

Section: Introductionmentioning

confidence: 99%

Self‐Adhesive Silicone Microstructures for the Treatment of Tympanic Membrane Perforations

Lana

Sorg

Wenzel

et al. 2021

Advanced NanoBiomed Research

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Inspired by the gecko foot, polymeric microstructures have demonstrated reliable dry adhesion to both stiff objects and sensitive surfaces such as skin. Microstructured silicone patches are proposed, herein, for the treatment of tympanic membrane perforations with the aim of serving as an alternative for current surgical procedures that require anesthesia and ear canal packing. Sylgard 184 PDMS micropillars of 20 μm in diameter and 60 μm in length are topped by a Soft Skin Adhesive (SSA) MG7‐1010 terminal layer, of about 25 μm thickness. The adhesion is evaluated by specially designed tack tests against explanted murine eardrums and, for comparison, against a rigid substrate. Functional effects are evaluated using auditory brainstem responses (ABRs) and distortion product otoacoustic emissions (DPOAE). The adhesion strength of the microstructure and unstructured controls to explanted murine tympanic membranes is comparable (typically 12 kPa), but the microstructured patches are easier to handle by the surgeon. For the first time, partial recovery of hearing performance is measured immediately after patch application. The novel patches adhere without the need for further fixation, removing the need for ear canal packing. The proposed material design holds great promise for improving clinical treatments of tympanic membrane perforations.

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Silicon foil patching for blast tympanic membrane perforation: a retrospective study

Cited by 6 publications

References 14 publications

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

A Systematic Review of Nonautologous Graft Materials Used in Human Tympanoplasty

Estimated Prevalence of Functional Hearing Difficulties in Blast-Exposed Service Members With Normal to Near–Normal-Hearing Thresholds

Self‐Adhesive Silicone Microstructures for the Treatment of Tympanic Membrane Perforations

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