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Application of Platelet Rich Fibrin Matrix to Repair Traumatic Tympanic Membrane Perforations: A Pilot Study

  • Rajendran Dinesh KumarEmail author
Original Article
  • 74 Downloads

Abstract

Trauma in the form of instrumentation, slap, blast, accident, and sporting injury can result in tympanic membrane (TM) perforations which spontaneously recover in 53–94%. The closure rates of TM perforation due to above causes do not vary greatly; however, some otolaryngologists prefer to perform immediate microsurgical procedures to accelerate the recovery process. Our aim is to study the efficacy of Trichloroacetic acid (TCA) Chemical Cauterization (50%) and Platelet rich fibrin (PRF) Plug Myringoplasty technique in healing traumatic tympanic membrane perforations. To evaluate the preoperative and postoperative hearing outcome from the procedure and compare them. Study design is prospective study. A pilot study was carried out amongst selected 25 patients with central perforations in the Department of ENT, for duration of 2 years from July 13 to July 15. All 25 patients underwent PTA assessment & TCA (50%) and Autologous PRF Plug Myringoplasty technique done and follow up to 6 months postoperatively. The success rate traumatic tympanic membrane closure was found to be 92%. Pre- and post-operative hearing assessments of each patient were done & showed statistically significant air–bone gap closure with success rate of 88% (p < 0.05). From this study, the closure rate in traumatic tympanic membrane perforation by TCA (50%) and PRF Plug Myringoplasty technique was 92% with statistically significant hearing improvement (88%). This technique can be recommended as a time and cost effective office based procedure for treatment of traumatic tympanic membrane perforations.

Keywords

Autologous Platelet rich fibrin Myringoplasty 

Notes

Compliance with Ethical Standards

Conflict of interest

None declared.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

Supplementary material 1 (WMV 6204 kb)

Supplementary material 2 (WMV 21221 kb)

References

  1. 1.
    Orji FT, Agu CC (2008) Determinants of spontaneous healing in traumatic perforations of the tympanic membrane. Clin Otolaryngol 33:420–426CrossRefGoogle Scholar
  2. 2.
    Lou ZC, Lou ZH, Zhang QP (2012) Traumatic tympanic membrane: a study of etiology and factors affecting outcome. Am J Otolaryngol 33:549–555CrossRefGoogle Scholar
  3. 3.
    Hempel JM, Becker A, Muller J, Krause E, Berghaus A, Braun T (2012) Traumatic tympanic membrane perforations: clinical and audiometric findings in 198 patients. Otol Neurotol 33:1357–1362CrossRefGoogle Scholar
  4. 4.
    Simsek G, Akin I (2014) Early paper patching versus observation in patients with traumatic eardrum perforations: comparisons. Of anatomical and functional outcomes. J Craniofac Surg 25:2030–2032CrossRefGoogle Scholar
  5. 5.
    Lou ZC, He JG (2011) A randomised controlled trial comparing spontaneous healing, gelfoam patching and edge-approximation plus gelfoam patching in traumatic tympanic membrane perforation with inverted or everted edges. Clin Otolaryngol 36:221–226CrossRefGoogle 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 145:581–585CrossRefGoogle Scholar
  7. 7.
    Choukroun J, Adda F, Schoeffler C, Vervelle A (2001) Une opportunite en paro-implantologie: le PRF. Implantodontie 42:55–62Google Scholar
  8. 8.
    Dohan DM, Chouknoun J, Diss A, Dohan SL (2006) Platelet rich fibrin (PRF): a second-generation platelet concentrate. Part I: technological concepts and evoluation. Oral Surg Oral Med Oral Pathol Oral Radiol Oral Endod 101:37–44CrossRefGoogle Scholar
  9. 9.
    Dohan DM, Choukroun J, Diss A, Dohan SL, Dohan AJ, Mouhyi J et al (2006) Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part II: platelet-related biologic features. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 101:e45–e50CrossRefGoogle Scholar
  10. 10.
    Erkilet E, Koyuncu M, Atmaca S, Yarım M (2009) Platelet-rich plasma improves healing of tympanic membrane perforations: experimental study. J Laryngol Otol 123:482–487CrossRefGoogle Scholar
  11. 11.
    Alvaro MLN, Ortiz N, Rodriguez L, Boemo R, Fuentes JF, Mateo A, Ortiz P (2011) Pilot study on the efficiency of the biostimulation with autologous plasma rich in platelet growth factors in otorhinolaryngology. Otol Surg (Tympanoplasty Type 1) ISRN Surg 2011:451020.  https://doi.org/10.5402/2011/451020 CrossRefGoogle Scholar
  12. 12.
    Banzer M (1640) Disputatio de auditione laesa. Dissertation on deafnessGoogle Scholar
  13. 13.
    Griffin WL Jr (1979) A retrospective study of traumatic tympanic membrane perforations in a clinical practice. Laryngoscope 89:261–282PubMedGoogle Scholar
  14. 14.
    Yearsley J (1863) Deafness practically illustrated. Churchill & Sons, LondonGoogle Scholar
  15. 15.
    Toynbee J (1853) On the use of an artificial membrana tympani in cases of deafness dependent upon perforations or destruction of the natural organ. J. Churchill & Sons, LondonGoogle Scholar
  16. 16.
    Roosa DB (1876) Diseases of the ear. William Wood, New YorkGoogle Scholar
  17. 17.
    Goldman NC (2007) Chemical closure of chronic tympanic membrane perforations. ANZ J Surg 77:850–851CrossRefGoogle Scholar
  18. 18.
    Joynt JA (1919) Repair of drum. Iowa Med Soc 9:51Google Scholar
  19. 19.
    Derlacki EL (1953) Repair of central perforations of tympanic membrane. Arch Otolaryngol 58:405CrossRefGoogle Scholar
  20. 20.
    Gun T, Sozen T, Boztepe OF, Gur OE, Muluk NB, Cingi C (2014) Influence of size and site of perforation on fat graft myringoplasty. Auris Nasus Larynx 41:507–512CrossRefGoogle Scholar
  21. 21.
    Lou Z, Wang Y (2015) Evaluation of the optimum time for direct application of fibroblast growth factor to human traumatic tympanic membrane perforations. Growth Factors 33:65–70CrossRefGoogle Scholar
  22. 22.
    Guneri EA, Tekin S, Yılmaz O, Ozkara E, Erdag TK, Ikiz AO et al (2003) The effects of hyaluronic acid, epidermal growth factor and mitomycin in an experimental model of acute traumatic tympanic membrane perforation. Otol Neurotol 24:371–376CrossRefGoogle Scholar
  23. 23.
    El-Anwar MW, El-Ahl MA, Zidan AA, Yacoup MA (2015) Topical use of autologous platelet rich plasma in myringoplasty. Auris Nasus Larynx 42:365–368CrossRefGoogle Scholar
  24. 24.
    Habesoglu M, Oysu C, Sahin S, Sahin-Yilmaz A, Korkmaz D, Tosun A et al (2014) Platelet-rich fibrin plays a role on healing of acute-traumatic ear drum perforation. J Craniofac Surg 25:2056–2058CrossRefGoogle Scholar
  25. 25.
    Yamazaki KIK, Sato H (2010) A clinical study of traumatic tympanic membrane perforation. Nippon Jibiinkoka Gakkai Kaiho 113:679–686CrossRefGoogle Scholar
  26. 26.
    Berger G, Finkelstein Y, Harell M (1994) Non-explosive blast injury of the ear. J Laryngol Otol 108:395–398CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  1. 1.Department of ENT and Head-Neck SurgeryPD Hinduja Sindhi HospitalBengaluruIndia

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