Autologous serum eardrops therapy with a chitin membrane for closing tympanic membrane perforations.
OBJECTIVE
Office treatment for chronic tympanic membrane (TM) perforations has limitations, and alternative methods to myringoplasty are sometimes needed. Serum lacks antigenicity and contains a large variety of growth factors known to modulate proliferation of various tissues to promote wound healing effects. Our purpose was to evaluate the feasibility of autologous serum eardrops therapy with a chitin membrane for closing TM perforations.


METHODS
In the outpatient clinic, the perforation margin was cauterized with silver nitrate, and the perforation was covered with a chitin membrane. Patients were instructed to apply autologous serum eardrops daily. Patients were examined every 2 weeks, and the procedure was repeated.


RESULTS
We treated 19 sequential patients with chronic TM perforation in 1 ear between October 2005 and September 2007. Closure of the TM was achieved in 11 (58%) of 19 ears, and reduction of the perforation size was observed in 2 ears (11%). Closure rates for small, medium, and large perforations were 57 (8 of 14), 0 (0 of 1), and 75% (3 of 4), respectively. Closure rates for perforations attributable to intratympanic dexamethasone treatment, after myringoplasty and chronic otitis media were 67 (2 of 3), 67 (2 of 3), and 54% (7 of 13), respectively. Time for closure took from 15 to 175 days, with an average of 68 days (5.9 clinic visits). During autologous serum eardrop therapy with a chitin membrane, no remarkable side effects in the treated ears were observed. Measurement of the concentration of the epidermal growth factor, transforming growth factor beta1, fibronectin, and interleukin 6 in the serum showed no decrease in 14 days, suggesting activity remained stable in that period.


CONCLUSIONS
Autologous serum eardrops therapy with a chitin membrane, which requires no surgical intervention, was found to be a promising office-based technique for the closure of chronic TM perforations because of its ease, safeness, and feasibility. However, additional studies are needed to independently analyze the specific benefits of the serum drops and the chitin membrane.
Kakehata
Seiji
S
Department of Otorhinolaryngology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. seijik@cc.hirosaki-u.ac.jp
Hirose
Yuki
Y
Kitani
Rei
R
Futai
Kazunori
K
Maruya
Shin-ichiro
S
Ishii
Kenji
K
Shinkawa
Hideichi
H
D000287:Administration, Topical; D000293:Adolescent; D000368:Aged; D002686:Chitin / Q000008:administration & dosage / Q000627:therapeutic use*; D002908:Chronic Disease; D004797:Enzyme-Linked Immunosorbent Assay; D004815:Epidermal Growth Factor / Q000097:blood; D005260:Female; D005353:Fibronectins / Q000097:blood; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D011108:Polymers / Q000008:administration & dosage / Q000627:therapeutic use; D044967:Serum; D053773:Transforming Growth Factor beta1 / Q000097:blood; D018058:Tympanic Membrane Perforation / Q000628:therapy*; D055815:Young Adult
D005353:Fibronectins; D015850:Interleukin-6; D011108:Polymers; D053773:Transforming Growth Factor beta1; D002686:Chitin; D004815:Epidermal Growth Factor