European Archives of Oto-Rhino-Laryngology

, Volume 270, Issue 1, pp 81–86 | Cite as

Biocompatibility evaluation of cigarette and carbon papers used in repair of traumatic tympanic membrane perforations: experimental study

  • Emine Elif Altuntaş
  • Zeynep Sümer


The purposes of this study were to investigate the biocompatibility of two different paper patches (carbon and cigarette papers) and compare the adhesion and proliferation features of L929 fibroblast cells by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT Test) test and scanning electron microscopy (SEM). In this study, time-dependent cytotoxic effects of cigarette and carbon papers used in repairing small traumatic TM perforations were investigated in vitro by using MTT test. And also adhesion and spreading of cells over disk surface were observed by SEM. Cytotoxicity test carried out by MTT analysis on leakage products collected from two types of paper patches at the end of 24 and 48 h revealed no cytotoxicity (P > 0.05). In SEM studies, it was observed that cells started to proliferate over disk surface as a result of 48-h incubation, and SEM revealed that the cell proliferation over cigarette paper was more compared to the one over carbon paper. We believe that this is the first study where biocompatibility and adhesion features of carbon and cigarette paper have been studied by using L929 fibroblast cell culture. As a result, biocompatibility of cigarette paper and also whether cigarette paper was superior to carbon paper in cell attachment and biocompatibility were studied. It was found, by MTT test and SEM test, that cigarette paper had a higher biocompatibility and cell attachment, and thus cigarette paper should be the patch to be preferred in cases where TM perforations are repaired by paper-patch method.


Tympanic membrane Traumatic perforation Paper patches Biocompatibility MTT test Scanning electron microscopy 



The authors wish to warmly thank Professor Haldun Sümer for her critical appraisal of the manuscript and statistical analysis.

Conflict of Interest



  1. 1.
    Kaftan H, Reuther L, Miehe B, Hosemann W, Beule A. Inhibition of fibroblast growth factor receptor 1: influence on tympanic membrane wound healing in rats. Eur Arch Otorhinolaryngol. 2011: [Epub ahead of print] PubMed PMID: 21590482Google Scholar
  2. 2.
    Kim J, Kim CH, Park CH, Seo JN, Kweon H, Kang SW, Lee KG (2010) Comparison of methods for the repair of acute tympanic membrane perforations: Silk patch vs. paper patch. Wound Repair Regen 18(1): 132–8. PubMed PMID: 20082686Google Scholar
  3. 3.
    Lilly-Tariah OB, Somefun AO (2007) Traumatic perforation of the tympanic membrane in University of Port Harcourt Teaching Hospital, Port Harcourt. Nigeria. Niger Postgrad Med J 14:121–124PubMedGoogle Scholar
  4. 4.
    Orji FT, Agu CC (2008) Determinants of spontaneous healing in traumatic perforations of the tympanic membrane. Clin Otolaryngol 33(5):420–426PubMedCrossRefGoogle Scholar
  5. 5.
    Kristensen S (1992) Spontaneous healing of traumatic tympanic membrane perforations in man: a century of experience. J Laryngol Otol 106(12):1037–1050. Review. PubMed PMID: 1487657Google Scholar
  6. 6.
    Park MK, Kim KH, Lee JD, Lee BD (2011) Repair of large traumatic tympanic membrane perforation with a steri-strips patch. Otolaryngol Head Neck Surg. [Epub ahead of print] PubMed PMID: 21593464Google Scholar
  7. 7.
    Dursun E, Dogru S, Gungor A, Cincik H, Poyrazoglu E, Ozdemir T (2008) Comparison of paper-patch, fat, and perichondrium myringoplasty in repair of small tympanic membrane perforations. Otolaryngol Head Neck Surg 138(3):353–356PubMedCrossRefGoogle Scholar
  8. 8.
    Imamoğlu M, Işik AU, Acuner O, Harova G, Bahadir O (1998) Fat-plug and paper-patch myringoplasty in rats. J Otolaryngol 27(6):318–321PubMedGoogle Scholar
  9. 9.
    Barch JM, Knutsen T, Spurbeck JL (1997) The cytogenetics laboratory manual, 3rd edn. Lippincot-Raven Publishers, PhiladelphiaGoogle Scholar
  10. 10.
    ISO (2009) Biological evaluation of medical devices- part 5: cytotoxicity tests: in vitro methods. ISO/Draft International Standard 10993-5. International Organization for StandardizationGoogle Scholar
  11. 11.
    Hiroshi I, Ohno T, Hatao M et al (1998) Validation study on five cytotoxic assays by JSAAE-VII, Details of the MTT assay. Altern Animal Test Exp 5:1–12Google Scholar
  12. 12.
    Qu H, Wei M (2006) The effect of fluoride contents in fluoridated hydroxyapatite on osteoblast behavior. Acta Biomater 2:113–119PubMedCrossRefGoogle Scholar
  13. 13.
    Al RH, Dahl JE, Morisbak E, Polyzois GL (2005) Irritation and cytotoxic potential of denture adhesives. Gerodontology 22:177–183PubMedCrossRefGoogle Scholar
  14. 14.
    Nishijima M, Hashimoto Y, Nakamura M (2002) Cytocompatibility of new phthalate ester-free tissue conditioners in vitro. Dent Mater J 21:118–132PubMedCrossRefGoogle Scholar
  15. 15.
    Nahid M, Bottenberg P (2003) Importance of cell cultures in biocompatible dental materials research. Rev Belge Med Dent 58:189–196Google Scholar
  16. 16.
    Berthold E (1879) Uber myringoplastik. Medicinisch-Chuutgisches Central-Blatt 14:195–207Google Scholar
  17. 17.
    Heermann H (1961) Trommelfellplastik mit Fasciengewebe vom M. temporalis nach Bergradigung vorderen Gehorgangswand. HNO 9:136–137PubMedGoogle Scholar
  18. 18.
    Laidlaw DW, Costantino PD, Govindaraj S, Hiltzik DH, Catalano PJ (2001) Tympanic membrane repeat with dermal allograft. Laryngoscope 111:702–707PubMedCrossRefGoogle Scholar
  19. 19.
    Quraishi MS, Jones NS (1995) Day case myringoplasty using tragal perichondrium. Clin Otolaryngol 20:12–14PubMedCrossRefGoogle Scholar
  20. 20.
    Chauvin K, Bratton C, Parkins C (1999) Healing large tympanic membrane perforations using hyaluronic acid, basic fibroblast growth factor, and epidermal growth factor. Otolaryngol Head Neck Surg 121:43–47PubMedCrossRefGoogle Scholar
  21. 21.
    Lim AA, Washington AP, Greinwald JH, Lassen LF, Holtel MR (2000) Effect of pentoxifylline on the healing of guinea pig tympanic membrane. Ann Otol Rhinol Laryngol 109:262–266PubMedGoogle Scholar
  22. 22.
    Blake CJ (1887) Transactions of the first congress of the international otological society (abstract). D. Appleton and Co, New York, p 125Google Scholar
  23. 23.
    Kristensen S, Juul A, Gammelgaard NP, Rasmussen OR (1989) Traumatic tympanic membrane perforations: complication and management. Ear Nose Throat J 68:503–516PubMedGoogle Scholar
  24. 24.
    Chun SH, Lee DW, Shin JK (1999) A clinical study of traumatic tympanic perforation. Korean J Otolaryngol 42:437–441Google Scholar
  25. 25.
    Kim JH, Bae JH, Lim KT, Choung PH, Park JS, Choi SJ, Im AL, Lee ET, Choung YH, Chung JH (2009) Development of water-insoluble chitosan patch scaffold to repair traumatic tympanic membrane perforations. J Biomed Mater Res A 90(2):446–455PubMedGoogle Scholar
  26. 26.
    Kim JH, Choi SJ, Park JS, Lim KT, Choung PH, Kim SW, Lee JB, Chung JH, Choung YH (2010) Tympanic membrane regeneration using a water-soluble chitosan patch. Tissue Eng Part A 16(1):225–232PubMedCrossRefGoogle Scholar
  27. 27.
    Spandow O, Hellström S, Dahlström M, Bohlin L (1995) Comparison of the repair of permanent tympanic membrane perforations by hydrocolloidal dressing and paper patch. J Laryngol Otol 109(11):1041–1047PubMedCrossRefGoogle Scholar
  28. 28.
    Camnitz PS, Bost WS (1985) Traumatic perforations of the tympanic membrane: early closure with paper tape patching. Otolaryngol Head Neck Surg 93(2):220–223PubMedGoogle Scholar
  29. 29.
    Kim J, Kim SW, Choi SJ, Lim KT, Lee JB, Seonwoo H, Choung PH, Park K, Cho CS, Choung YH, Chung JH (2011) A healing method of tympanic membrane perforations using three-dimensional porous chitosan scaffolds. Tissue Eng Part A 17(21–22): 2763–72. Epub 2011 Jul 28. PubMed PMID: 21689058Google Scholar
  30. 30.
    Golz A, Goldenberg D, Netzer A, Fradis M, Westerman ST, Westerman LM, Joachims HZ (2003) Paper patching for chronic tympanic membrane perforations. Otolaryngol Head Neck Surg 128(4):565–570PubMedCrossRefGoogle Scholar
  31. 31.
    Dursun E, Dogru S, Gungor A, Cincik H, Poyrazoglu E, Ozdemir T (2008) Comparison of paper-patch, fat, and perichondrium myringoplasty in repair of small tympanic membrane perforations. Otolaryngol Head Neck Surg 138(3):353–356PubMedCrossRefGoogle Scholar
  32. 32.
    Weber DE, Semaan MT, Wasman JK, Beane R, Bonassar LJ, Megerian CA (2006) Tissue-engineered calcium alginate patches in the repair of chronic chinchilla tympanic membrane perforations. Laryngoscope 116(5):700–704PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Ear Nose and Throat Education and Research Hospital, Faculty of MedicineUniversity of CumhuriyetSivasTurkey
  2. 2.Department of Microbiology, Faculty of MedicineUniversity of CumhuriyetSivasTurkey
  3. 3.Department of OtorhinolaryngologyCumhuriyet University School of MedicineSivasTurkey

Personalised recommendations