Repair of the tympanic membrane with urinary bladder matrix.
OBJECTIVE
To test urinary bladder matrix (UBM) as a potential treatment for tympanic membrane (TM) healing and regeneration.


METHODS
This prospective pilot study was designed to provide both qualitative and semiquantitative assessment of temporal and spatial healing events in the chinchilla model of chronic TM perforations with and without UBM patching.


METHODS
Bilateral myringotomies were performed and repeated as necessary to create subtotal perforations over an 8-week period. Myringoplasty was then performed, with left TMs serving as controls and right TMs receiving UBM patches. TMs were excised at 4 weeks, 8 weeks, and 12 weeks. Fixed tissue samples were characterized for gross morphology, then processed for microscopic evaluation.


RESULTS
Chronic perforations were maintained with one or more repeated myringotomies. Although both control and patched TMs were thicker than native tissue, patched TMs were transparent and uniform in thickness without any inclusions. UBM patches were readily degraded and replaced by newly deposited and organized host tissue that recapitulated the native TM layers.


CONCLUSIONS
UBM scaffolds were an effective biological scaffold for TM closure and tissue remodeling, leading to thicker than normal anatomy but otherwise normal morphology. Future studies are required to determine functional and temporal outcomes as well as alternative patch orientations. The results show particular promise as a superior alternative means of reconstructing not only chronic TM perforations but also dimeric TMs associated with retraction pockets and atelectasis. Laryngoscope, 2009.
Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Aron
A
Parekh
Belinda
B
Mantle
Juliane
J
Banks
J Douglas
JD
Swarts
Stephen F
SF
Badylak
Joseph E
JE
Dohar
Patricia A
PA
Hebda
D020341:Absorbable Implants; D000818:Animals; D002682:Chinchilla; D004195:Disease Models, Animal; D005109:Extracellular Matrix; D048091:Guided Tissue Regeneration / Q000379:methods*; D009225:Myringoplasty / Q000379:methods*; D010865:Pilot Projects; D012038:Regeneration / Q000502:physiology; D013552:Swine; D054457:Tissue Scaffolds; D014432:Tympanic Membrane / Q000473:pathology; D018058:Tympanic Membrane Perforation / Q000473:pathology / Q000601:surgery*; D001743:Urinary Bladder / Q000737:chemistry*; D014945:Wound Healing / Q000502:physiology